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 Healthcare Common Procedure Coding System (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.

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
  • Medically Necessary Exceptions
  • 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

  • All Patient Refined Diagnosis Related Group (APR-DRG)
  • Certified Community Behavioral Health Clinics
  • Hospice Inpatient Per Diem
    • Independent Rural Health Clinics
    • The Independent Rural Health Clinic (IRHC) MO HealthNet Interim Rate List contains the interim rate per visit for IRHCs participating in the MO HealthNet program. IRHCs are reimbursed on an interim basis at the rate noted on this list and a final cost settlement is determined on the facility's annual cost report. MHD reimburses IRHCs on an interim basis at the Medicare Maximum Interim IRHC Rate, unless a provider requests a lower rate. The IRHC Rate List is updated at the beginning of each calendar year to reflect the new MO HealthNet Interim Rate effective January 1st and is updated, if needed, to reflect new or terminating facilities and rate changes. The general program policies and procedures governing the MO HealthNet IRHC Program are set forth in 13 CSR 70-94.010, Independent Rural Health Clinic Program.
    • This report is for informational purposes only and MHD is not responsible for how outside parties utilize the information. The information in this report is current as of the date on the list and is true and accurate to the best of MHD’s knowledge.
    • If you have any questions regarding this report or the MO HealthNet IRHC program, please contact the Clinic Policy & Reimbursement Manager of the Institutional Reimbursement Unit at 573-751-5663.
    • IRHCs that are contracted with a health plan to provide managed care services to MO HealthNet participants. According to the terms of the Managed Care Health Plan Contract, health plans are to reimburse IRHCs one hundred percent (100%) of the interim rate per visit reflected on this list. For further information on Managed Care, visit Managed Care Health Plans. If you have any questions regarding the MO HealthNet Managed Care Program for IRHCs, please contact Constituent Servies at 800-392-2161.
    Nursing Facility
    • The Nursing Facility Rate List contains the per diem rate for nursing facilities participating in the MO HealthNet Program. Nursing facility rates are updated each January and July, as set forth in state regulation. Payments to facilities based on rates that are not final (i.e., facility is operating under an interim rate, rate is under appeal, etc.) may be subject to retroactive settlement, including recoupment. MHD will make any retroactive settlements to the provider of record, regardless of the provider for the applicable dates of service. The general program policies and procedures governing the MO HealthNet Nursing Facility Program are set forth in 13 CSR 70-10.020, Prospective Reimbursement Plan for Nursing Facility and HIV Nursing Facility Services. This regulation, as well as other applicable nursing facility regulations, may be accessed on the Missouri Secretary of State website.
    • This rate list is for informational purposes only and MHD is not responsible for how outside parties use the information. The information in this report is current as of the date on the list and is true and accurate to the best of MHD’s knowledge.
    • If you have any questions regarding this rate list or the Nursing Facility Program, please contact the Nursing Facility Policy & Reimbursement Manager of the Institutional Reimbursement Unit at 573-751-5663.
    • Hospice Nursing Home Room and Board. Hospice providers that furnish hospice services to MO HealthNet participants in a nursing facility are reimbursed ninety- five percent (95%) of the nursing facility’s per diem rate for room and board. Hospice providers operating in nursing facilities without a final rate are also subject to retroactive settlement. The general policies and procedures governing the MO HealthNet Hospice Program are set forth in 13 CSR 70-50.010, Hospice Services Program.

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.


Previous Fee Schedule Name Fee Schedule Name Effective July 1, 2026
Anesthesia - Certified Registered Nurse Anesthetist/Anesthesiologist Assistant Anesthesia
Anesthesia - General Anesthesia
Anesthesia - Supervision of Anesthetists Anesthesia
DME Purchase Durable Medical Equipment and Supplies
DME Rental Durable Medical Equipment and Supplies
DME Repair Durable Medical Equipment and Supplies
EPSDT Other Services Certified Community Behavioral Health Clinics Rate List
EPSDT Other Services First Steps
EPSDT Other Services Environmental Lead Assessment
EPSDT Other Services Practitioner
EPSDT Other Services Prescribed Pediatric Extended Care
EPSDT Other Services Private Duty Nursing
EPSDT Other Services School-Based Individualized Education Program Services
Medical Services Adult Day Care Waiver
Medical Services AIDS Waiver
Medical Services Aged and Disabled Waiver
Medical Services Brain Injury Waiver
Medical Services Certified Community Behavioral Health Clinics Rate List
Medical Services Department of Health and Senior Services Reassessor
Medical Services Independent Living Waiver
Medical Services Medically Complex Adult Waiver
Medical Services Personal Care
Medical Services Practitioner
Medical Services Private Duty Nursing
Medical Services School-Based Individualized Education Program Services
Medical Services Structured Family Caregiving Waiver
Other Medical Aged and Disabled Waiver
Other Medical Adult Day Care Waiver
Other Medical Ambulatory Surgical Center
Other Medical Behavioral Health Adult Targeted Case Management
Other Medical Behavioral Health Youth Targeted Case Management
Other Medical Certified Community Behavioral Health Clinics Rate List
Other Medical Community Support Waiver
Other Medical Comprehensive Community Support
Other Medical Missouri Children's Developmental Disabilities Waiver
Other Medical Partnership for Hope Waiver
Other Medical Personal Care
Other Medical Practitioner
Other Medical Targeted Case Management for Individuals with Developmental Disabilities
Other Services Adult Day Care Waiver
Other Services Community Support Waiver
Other Services Comprehensive Community Support
Other Services Comprehensive Community Support Division of Youth Services
Other Services Home Health
Other Services Missouri Children's Developmental Disabilities Waiver
Other Services Partnership for Hope Waiver
Surgery-Assistant Surgery Practitioner
Surgery-Postoperative Services Practitioner
Surgery-Without Postoperative Services Practitioner
Surgery and Epidurals Practitioner

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


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.