COVID-19: COVID-19 Testing and Specimen Collection Reimbursement

During the COVID-19 public health emergency, effective with dates of service on or after March 1, 2020, the state plan allowed MO HealthNet to reimburse all providers 100% of the Medicare rate for COVID-19 testing and specimen collection codes.

The COVID-19 public health emergency will expire on May 11, 2023. Effective May 12, 2023, the state plan will require MO HealthNet to reimburse for COVID-19 testing and specimen collection codes performed in the outpatient setting 90% of the Medicare rate and independent laboratories 80% of the Medicare rate.

COVID-19: Certificate of Medical Necessity Form (CMN) Signature Requirement

During the COVID PHE, MO HealthNet temporarily waived the original signature requirement on Certificate of Medical Necessity Form (CMN) that requires an original signature.

The COVID PHE will expire on May 11, 2023. Effective May 12, 2023, this requirement will no longer be waived.

Certain DME requires a CMN. Original signatures are required for Fields 7 and 14. Refer to the DME Provider Manual Section 13.15.B for details on the Direct Delivery Requirements and Section 7.2 for details on the CMN process.

COVID-19: Telemedicine Services

During the COVID-19 public health emergency (PHE), MO HealthNet (MHD) reminded providers of program policies around telemedicine services.

The COVID-19 public health emergency will expire on May 11, 2023. Effective May 12, 2023 MO HealthNet, will continue to allow any licensed health care provider, enrolled as a MO HealthNet provider, to provide telehealth services if the services are within the scope of practice for which the health care provider is licensed. The services must be provided with the same standard of care as services provided in person.

COVID-19: Radiology - Chest CT Scans

During the COVID-19 public health emergency (PHE), MO HealthNet (MHD) did not require providers to obtain prior authorization for Chest CT Scan HCPCS codes 71250, 71260, and 71270 when the following COVID-19 related diagnosis codes were present: B34.2, B97.29, J12.89, J20.8, J22, J40, J80, J96.00, J96.01, J96.02, J96.20, J96.21, J96.22, J98.8, P22.0, P28.5, R05, R06.02, R09.02, R50.9, Z03.818, Z09, Z20.828, Z86.19, Z11.52, Z20.822, Z86.16, M35.81, M35.89 and J12.82.

COVID-19 Vaccines

During the COVID-19 public health emergency (PHE), if a participant was enrolled in a Managed Care Organization (MCO), the administration of the COVID-19 vaccine was billed to the MO HealthNet Fee-for-Service program, and not to the MCO.

The COVID-19 public health emergency will expire on May 11, 2023. Effective May 12, 2023, the administration of the COVID-19 vaccine will be billed to the MCO.

If a participant is not enrolled in an MCO, the administration of the COVID-19 vaccine will be billed to the MO HealthNet Fee-for-Service program.

Extended/Uninsured Women's Health Services COVID-19 Testing

During the COVID-19 public health emergency (PHE), MO HealthNet Division covered COVID-19 testing for participants in the State-funded categories of assistance for Extended/Uninsured Women’s Health Services (Medicaid eligibility codes 80 and 89).

The COVID-19 PHE will expire on May 11, 2023. Effective May 12, 2023, MO HealthNet Division will no longer cover COVID-19 testing for participants in the State-funded categories of assistance for Extended/Uninsured Women’s Health Services (Medicaid eligibility codes 80 and 89).

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