MHD Price List Search - Main Disclaimer

ATTENTION PROVIDERS

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 month. 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.

Effective August 23, 2022, for dates of service on or after July 1, 2022, the 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 for a Healthcare Common Procedure Coding System/Current Procedural Terminology (HCPCS/CPT) code is the maximum units of service that a provider would report under most circumstances for a single participant on a single date of service. Not all HCPCS/CPT codes have an MUE assigned by CMS. If there is no MUE for a code, providers should use the MO HealthNet maximum quantity on the online fee schedule.


General Fee Schedule Information

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 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
  • Dental
  • Home Health
  • Physical Disabilities Waiver

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


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