MO HealthNet Division Fee Schedules and Rate Lists

ATTENTION PROVIDERS

MO HealthNet Fee Schedules are updated each month. However, simply finding a code in the pricing file does not guarantee it is appropriate for a specific claim; providers must always consult program specific Provider Manuals and Bulletins to ensure correct coding.

MO HealthNet Fee Schedules are generally categorized by provider type; however, certain Current Procedural Terminology (CPT) codes may be billed by multiple different provider types.

For programs not paid via a fee schedule, procedure codes will still show as covered with a listed fee, but providers must refer to the program specific Provider Manuals and Bulletins for limitations and restrictions.

MO HealthNet Division (MHD) requires providers to follow Centers for Medicare & Medicaid Services (CMS) National Correct Coding Initiative (NCCI) Medically Unlikely Edits (MUE).

An MUE represents the maximum number of service units a provider can typically report for a single participant on a single date of service. Because CMS does not assign an MUE to every single HCPCS or CPT code, providers must look for an alternative limit when one is missing. If a specific code lacks a CMS-assigned MUE, providers are required to follow the default MHD maximum quantity established in the Individual Program Type files.

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General Fee Schedule Information

The MO HealthNet Fee Schedules listed below are the MO HealthNet maximum allowable fees which are in effect as of the date of the Fee Schedule publication date. For more specific information, refer to Provider Manuals and Bulletins.

• Adult Day Care Waiver
• Aged and Disabled Waiver
• AIDS Waiver
• Ambulance
• Ambulatory Surgical Centers
• Anesthesia
• Applied Behavioral Analysis
• Behavioral Health
• Behavioral Health Adult Targeted Case Management
• Behavioral Health Youth Targeted Case Management
• Brain Injury Waiver
• Community Psychiatric Rehabilitation
• Community Support Waiver
• Comprehensive Community Support Division of Youth Services
• Comprehensive Day Rehabilitation
• Comprehensive Substance Treatment and Rehabilitation
• Comprehensive Waiver
• Dental
• Department of Health and Senior Services Reassessor
• Doula
• Durable Medical Equipment
• Environmental Lead Assessment
• First Steps
• Free Standing Birth Center
• Hearing Aid
• Home Health
• Independent Laboratory – Professional Component
• Independent Laboratory – Technical Component
• Independent Laboratory – Professional and Technical Component
• Independent Living Waiver
• Medically Complex Adult Waiver
• Missouri Children's Developmental Disabilities Waiver
• Nurse Midwife
• Optometrist and Optician
• Outpatient Hospital
• Partnership for Hope Waiver
• Personal Care
• Podiatry
• Practitioner
• Prescribed Pediatric Extended Care
• Private Duty Nursing
• Radiology – Professional Component
• Radiology – Technical Component
• Radiology – Professional and Technical Component
• Rehabilitation Center
• School-Based Individualized Education Program Services
• Structured Family Caregiving Waiver
• Targeted Case Management for Individuals with Developmental Disabilities

Other Rate Lists

• All Patient Refined Diagnosis Related Group (APR-DRG)
• Certified Community Behavioral Health Clinics
• Hospice
• Inpatient Per Diem
• Nursing Facility

Specific information regarding modifiers may be found at the Modifier Information Link.

Fee Schedule Crosswalk

Due to the CMS guidelines that fee schedules must be easier for both providers and the public to understand, new fee schedules were created, and some have been combined. Listed below is a crosswalk of the fee schedules that were changed and the new fee schedule name.

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To review the Individual Program Type files, use the Download option below.

Note: As of July 1, 2026, the online fee schedule full search is discontinued.

• Individual Program Type files in XLSX format for download.

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