MedicaidCoverageMedium impact
Reimbursement for Specialized Formulas for WIC Enrolled Participants
Missouri Medicaid (MO HealthNet)·MO · Pediatrics·Provider Bulletin
Effective date
Jul 1, 2026
We identified it
Jun 20, 2026
Summary
Effective July 1, 2026, MO HealthNet will now reimburse DME providers for specialized enteral formulas (12 HCPCS codes) for participants dually enrolled in MO HealthNet and WIC programs. Reimbursement will follow the same quantities, limitations, and rates as other MO HealthNet participants. Billing teams must update systems to recognize these codes as covered for dual-enrollment patients and verify eligibility before service delivery.
Action Required
By June 30, 2026: Billing team must update DME billing system to cover HCPCS codes B4149, B4150, B4152, B4153, B4154, B4155, B4157, B4158, B4160, B4161, and B4162 when patient eligibility shows dual enrollment in MO HealthNet and WIC. Configure system to apply standard MO HealthNet quantities, limitations, and reimbursement rates from the current DME Fee Schedule and DME Provider Manual for these codes. Train front desk and verification staff to confirm dual-program enrollment during patient eligibility checks using the MO HealthNet card swipe, Provider Communications line (573-751-2896 or toll-free 833-222-7916), or eMOMED. Update DME provider contracts and internal guidelines to reflect coverage. For Managed Care plans, contact individual MC health plans to confirm prior authorization requirements, as MC plans may impose additional requirements beyond FFS guidance. Failure to implement will result in claim denials for dual-enrolled WIC participants requesting specialized formulas.