MedicaidAdministrativeHigh impact
REVISED Diagnosis Code Requirements for Pharmacy Claims
Missouri Medicaid (MO HealthNet)·MO·Pharmacy
Effective date
Jun 1, 2026
We identified it
Jun 20, 2026
Summary
Starting June 1, 2026, MO HealthNet will eliminate manual overrides for pharmacy claims missing or incorrectly formatted ICD-10 diagnosis codes. All pharmacy claims for specific medications must include valid, billable ICD-10 codes in NCPDP field 492-DO 424-DO without decimal points to process successfully.
Action Required
By June 1, 2026: Pharmacy staff must ensure all ICD-10 diagnosis codes are obtained from prescribers and entered in NCPDP field 492-DO 424-DO without decimal points. Contact pharmacy software vendor immediately to configure system to remove decimal points from diagnosis codes before claim submission. Update pharmacy procedures to require valid, billable ICD-10 codes for all medications subject to Diagnosis Code Required Policy Edit. Claims without proper codes will be rejected with no manual override option.