Effective for dates of service on or after July 1, 2024, MO HealthNet (MHD) has increased the home health agency per visit rate from $125.19 to $137.61.
MHD will reimburse the lower of the provider's billed charge or the maximum allowable amount for the date of service billed. Providers may not bill MHD at a higher rate than they charge their private pay patients. Providers must bill MHD their usual and customary rate.
It is the Department of Social Services' expectation that a substantial portion of the rate increase will be passed through to the direct care worker/nurse providing direct care services.
Annual Outpatient Hospital Simplified Fee Schedule
Outpatient Hospital Simplified Fee Schedule
Applies to: All Hospitals Providing Outpatient Services
Effective date: July 1, 2024
- Annual Outpatient Hospital Simplified Fee Schedule Rate Update
- Multiple Procedure Discounting
- Modifier 50 Bilateral Procedure Pricing
Annual Outpatient Hospital Simplified Fee Schedule Rate Update
The MO HealthNet Division (MHD) updates the Outpatient Hospital Simplified Fee Schedule (OSFS) annually in July. The OSFS is published on the MO HealthNet Fee Schedules website. To navigate the site, users must agree to the licensure terms and conditions, select "Download" or "Full Search," and select "Outpatient Hospital".
For information on how to utilize the MHD Fee Schedule, as well as other useful resources, providers may register for a program specific webinar by reviewing the Provider Training Calendar.
Multiple Procedure Discounting
Effective for dates of service on or after July 1, 2024, MHD applies multiple procedure discounting for those procedure codes identified as "Procedure or Service, Multiple Procedure Reduction Applies" under Medicare OPPS Addendum D1. These procedures are paid separately but are discounted when two or more services are billed on the same date of service. Procedure codes considered for the multiple procedure reduction under the OSFS exclude dental procedures. The multiple procedure claim line with the highest allowed amount is priced at one hundred percent (100%) of the maximum allowed amount. The second and subsequent covered procedures are priced at fifty percent (50%) of the maximum allowed amount.
Pharmacy Program Reimbursement
Applies to: Pharmacy Providers
Effective date: July 1, 2024
- Professional Dispensing Fee
Due to the increase in the Missouri Pharmacy Reimbursement Allowance (Pharmacy Tax), the adjustment to account for the Medicaid-reimbursed prescriptions will be increased effective July 1, 2024. In-state pharmacy providers will continue to receive a professional dispensing fee of $12.22, plus an adjustment to account for the cost of the Missouri Pharmacy Reimbursement Allowance attributable to Medicaid-reimbursed prescriptions. The professional dispensing fee plus the current adjusted amount will total $12.42.
Out-of-state pharmacy providers will continue to receive a professional dispensing fee of $8.85. Long-term care pharmacy providers supplying covered drugs to participants in long-term care facilities will continue to receive an additional $0.50 dispensing fee.
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