The MO HealthNet Division (MHD) is responding to an outbreak of respiratory disease caused by a novel (new) coronavirus. The virus has been named "SARS-CoV-2" and the disease it causes has been named "coronavirus disease 2019" (abbreviated "COVID-19").
As posted in the 05/21/2020 hot tip, effective with dates of service on or after March 1, 2020 providers do not need to obtain prior authorization for Chest CT Scan HCPCS codes 71250, 71260, and 71270 when the following COVID-19 related diagnosis codes are 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, and Z86.19. Effective January 1, 2021 the following COVID-19 related diagnosis codes have been added: Z11.52, Z20.822, Z86.16, M35.81, M35.89 and J12.82. The MHD will continue to waive the co-payment for these procedures.
Prior authorizations for ALL procedures managed by the MHD’s Radiology Benefit Manager (RBM) will be approved for 90 days during the COVID-19 crisis. The list of procedures the RBM manages can be found here: https://www.healthhelp.com/wpcontent/uploads/MOHTN_PROCCODES.pdf
This Hot Tip also applies to providers that are contracted with the Managed Care Organizations.