In order to access the File Download Page or the Online Search Page, you must read through the below information.
The fee schedules are updated each quarter. Pricing files are used by all MO HealthNet Providers. A code may not be appropriate for your claim even though it is listed in the pricing file. This is especially true for the categories entitled EPSDT, Medical, and Other Medical. Please refer to your program specific manual and bulletins for correct coding.
MO HealthNet providers are categorized by the service(s) they perform for the MO HealthNet eligible participants. The service by which providers are classified will determine the procedures for which they receive MO HealthNet reimbursement. However, some CPT codes may be billed by multiple provider types.
For programs not paid via a fee schedule, procedure codes will show as covered with a fee listed. If you are paid by percentage, per diem rate, etc., you will continue to be paid in that manner. Again, please refer to the program specific manual and bulletins for limitations and restrictions.
The four categories listed below have a variety of codes, which may be appropriate for many providers and services. Please use this as a reference when searching in these categories. For more specific information refer to the provider manuals and bulletins.
MEDICAL
Advance Practice Nurse/Nurse Practitioners
Aged and Disabled Waiver
Case Management for Pregnant Women
Clinics
Diabetic Educators
Federally Qualified Health Centers
Independent Living Waiver
Personal Care
Pharmacists
Physicians
Psychologists
Rural Health Clinics
OTHER MEDICAL
Ambulatory Surgical Centers
Advance Practice Nurse/Nurse Practitioners
Comprehensive Day Rehabilitation Centers
Independent Laboratories
MOCDDS Waiver
MRDD Community Support Waiver
MRDD Comprehensive Waiver
Occupational Therapists
Outpatient Hospitals
Outpatient Physicians
Physical Therapists
Rehabilitation Centers
Speech Therapists
Targeted Case Management - MRDD, SMI, SED
EPSDT
Counselors
Environmental Lead Assessors
Lead/HCY Case Management
Occupational Therapists
Physical Therapists
Private Duty Nursing
Social Workers
Speech Therapists
OTHER SERVICES
Adult Day Health Care
AIDS Waiver
Home Health
Physical Disabilities Waiver
Specific information regarding modifiers may be found at the Modifier Information Link.
