New Provider Updates 06/7/2024

New Updates have been posted to MO HealthNet

June 07, 2024 Bulletins Revised Breast Pump Bulletin Durable Medical Equipment (DME) Program Applies to: MO HealthNet Fee-For-Service DME Providers Effective date: April 1, 2024 Manual (E0602) and Electric (E0603) Breast Pumps Replacement of Purchased Items   Manual (E0602) and Electric (E0603) Breast Pumps Effective for dates of service on or after April 1, 2024, the MO HealthNet Division (MHD) will allow reimbursement for manual and electric breast pumps as purchase-only items. Participants must be in their third term of pregnancy to qualify for coverage. Prior authorization is not required. Participants are limited to one (1) manual or one (1) electric pump per lifetime. Services through the Missouri Women, Infants, and Children (WIC) program should be exhausted before billing MHD. Read more...   Hot Tips  Webinar on Dental Procedures Performed in Ambulatory Surgical Centers Please join the MO HealthNet Division (MHD) on June 17, 2024, for a training specifically for Ambulatory Surgical Center (ASC) providers covering how to bill for dental procedures. This is a one-hour virtual training beginning at 1:00 pm.  The training will cover the information below, as well as additional billing information and MHD resources. Effective for dates of service on or after July 1, 2023, MHD implemented a new ASC fee schedule based on Medicare's ASC payment system. The state-developed fees for covered ASC surgical procedures are based on 90% of the Medicare ASC rates, effective January 1 of each year.  MHD reimburses MO HealthNet-enrolled ASCs for dental procedures performed in their facilities. Under the new ASC payment methodology, providers should bill using the Current Dental Terminology© (CDT) codes included on the MHD Fee Schedule under "Other Medical," with the SG modifier, to receive maximum reimbursement for services. Providers should contact MHD.ClinicalServices@dss.mo.gov if a CDT code for a procedure with the SG modifier is not found on the MHD Fee Schedule. This information also applies to providers contracted with MHD's Managed Care Organizations. Register today for the June 17th Dental Procedures Performed in Ambulatory Surgical Centers webinar. Review Navigating Provider Resources or register for an upcoming provider training for more information on MHD Fee Schedules. Alcohol Use Disorder  Alcohol use increased dramatically during the pandemic, and research shows that usage is continuing to increase. Reports from the Substance Abuse and Mental Health Services Administration shows that the percentage of the US population that reports drinking and binge drinking are both still trending upward. MO HealthNet's goal is to raise awareness about the services and treatments available for participants with AUD. Studies show that both medications and counseling can be successful in treating AUD. Review the new AUD Fact Sheet to learn more. Contact us if you have questions. Pharmacy Preferred Drug List & Utilization Management Edit 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 6/06/2024: Antibiotics, Vaginal PDL Edit Brand Over Generic Fiscal Edit Dose Optimization Fiscal 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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