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Complementary Health and Alternative to Chronic Pain Management
Act
by Jun 30, 2026
Effective date
Jul 1, 2026
Identified
Jun 20, 2026
Summary
Effective July 1, 2026, MO HealthNet will discontinue coverage for physical therapy, chiropractic therapy, and acupuncture services under the Complementary Health and Alternative to Chronic Pain Management Program. All pre-certifications for these services approved beyond July 1, 2026 will be closed as of June 30, 2026. Cognitive Behavioral Therapy (CBT) remains covered with specific code and precertification requirements.
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What to do
by Jun 30, 2026 · 6 steps
01Billing team must update billing software to deny all claims with CPT codes 97012, 97014, 97032, 97035, 97110, 97161, 97162, 97163, 97530 (physical therapy); 97810, 97811, 97813, 97814 (acupuncture); and 98940, 98941, 98942, 98943 (chiropractic) when billed with modifier X4 for MO HealthNet claims with dates of service on or after July 1, 2026.
02Contact all current patients with active pre-certifications for physical therapy, chiropractic, or acupuncture services under this program and notify them of coverage termination effective June 30, 2026.
03Providers must immediately stop requesting new pre-certifications for these services after June 30, 2026.
04Update patient communication materials and encounter forms to reflect that these services are no longer covered under the Complementary Health and Alternative to Chronic Pain Management Program.
05For physical therapy, direct eligible patients ages 0-20 to the MO HealthNet Therapy Program instead.
06For CBT services, ensure proper precertification is obtained for psychotherapy codes (90832-90853) with diagnosis codes F45.41 and F45.42; note that health and behavior assessment codes (96150-96154) do not require precertification and can be provided for any physical health condition.
If missed: Failure to deny non-covered codes will result in claim denials and potential recovery actions.
Codes mentioned
9701297014970329703597110971619716297163975309781097811978139781498940989419894298943992029920399204992059921199212992139921499215908329083490837908469084790849908539615096151961529615396154F45.41F45.42
Original notice
Complementary Health and Alternative to Chronic Pain Management
mydss.mo.gov · Always check the source before changing claims.
Related changes
See all Missouri Medicaid (MO HealthNet) changes →Removal of Precertification Requirements for Psychotherapy ServicesHighEffective Sep 1, 2026 · Provider BulletinReminder of Precertification Requirements for Behavioral Health, Psychotherapy ServicesHighEffective Sep 7, 2023 · Provider NoticeBehavioral Health Recertification RefresherHighEffective Jul 28, 2022 · Provider NoticeBehavioral Health Precertification Refresher:MediumEffective Nov 17, 2023 · Provider NoticeBrowse every Missouri Medicaid (MO HealthNet) change in the policy list
Related policy hubs
Missouri Medicaid (MO HealthNet) policiesMO policy changesPhysical TherapyChiropracticPain ManagementPsychiatryPM&R (Physical Medicine & Rehab)Code 97012Code 97014Code 97032Code 97035Code 97110Code 97161Code 97162Code 97163Code 97530Code 97810Code 97811Code 97813Code 97814Code 98940Code 98941Code 98942Code 98943Code 99202Code 99203Code 99204Code 99205Code 99211Code 99212Code 99213Code 99214Code 99215Code 90832Code 90834Code 90837Code 90846Code 90847Code 90849Code 90853Code 96150Code 96151Code 96152Code 96153Code 96154Code F45.41Code F45.42