New Provider Updates 06/14/2024

New Updates have been posted to MO HealthNet

June 14, 2024 Bulletins Dental Program Dental Program Applies to: MO HealthNet Fee-For-Service Dental Providers Effective date: July 1, 2024 Coverage of Current Dental Terminology (CDT) Code D0120 (Periodic Oral Evaluation – Established Patient) for Adults Age 21 and Older Quantity, Limitations, and Reimbursement Rate   Coverage of CDT Code D0120 (Periodic Oral Evaluation – Established Patient) for Adults Age 21 and Older Pending Centers for Medicare & Medicaid Services (CMS) approval, effective for dates of service on and after July 1, 2024, the MO HealthNet Division (MHD)Fee-For-Service Dental Program will cover CDT code D0120 (periodic oral evaluation – established patient) for adults age 21 and older. Upon approval of the State Plan Amendment by CMS, MHD will recycle denied claims for dates of service on or after July 1, 2024. Quantity, Limitations, and Reimbursement Rate MHD will allow the same quantity, limitations, and reimbursement rate for adults age 21 and older as currently allowed for children age 20 and younger, blind, pregnant, and nursing home participants    D0120 is reimbursed two (2) times per calendar year. Providers may bill D0120 one (1) time for dates of service that occur between the months of January and June and one (1) time for dates of service that occur between the months of July and December. The reimbursement rate is $48.80. Read more...   Pharmacy Preferred Drug List & Utilization Management Edits Update MO HealthNet is required to complete an annual review of all drug coverage criteria per 13 CSR 70-20.200 Drug Prior Authorization Process. Web page: https://mydss.mo.gov/mhd/pharmacy-clinical-edits-pdl   Existing Edit update as of 6/14/2024: Brand Over Generic Fiscal Edit Manufacturers Requiring Prior Authorization Fiscal Edit Targeted Immune Modulators, Select Agents PDL Edit   Learn More To see all hot tips, bulletins, and newsletters, visit MO HealthNet News. To find more resources, visit the MO HealthNet Provider page. Contact Us For questions about pharmacy or MORx, please email: MHD.PharmacyAdmin@dss.mo.gov. For questions about psychology, exceptions, or medical pre-certifications, please email: Clinical.Services@dss.mo.gov For all other questions or comments, please email: Ask.MHD@dss.mo.gov Our Mission: Empower Missourians to live safe, healthy, and productive lives.     Note: replies to this email address will not be monitored.

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