MedicaidAdministrativeHigh impact
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 no longer provide manual overrides for pharmacy claims rejected due to missing or incorrectly formatted ICD-10 diagnosis codes. All pharmacy claims for certain medications must include valid, billable ICD-10 codes in NCPDP field 492-DO without decimal points to be processed successfully.
Action Required
By June 1, 2026: Billing team must contact pharmacy software vendor immediately to ensure system compliance with NCPDP field 492-DO requirements, removing decimal points from ICD-10 diagnosis codes before claim submission. Verify that all pharmacy claims include valid, billable ICD-10 codes obtained directly from prescribers. Claims without proper diagnosis codes will be rejected with no manual override available.