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CMS Approves Ground Ambulance Transport to Behavioral Health Crisis Centers (BHCCs) State Plan Amendment (SPA)
Act
by Dec 31, 2025
Effective date
Jan 1, 2026
Identified
Jun 20, 2026
Summary
CMS approved a Missouri Medicaid State Plan Amendment effective January 1, 2026, authorizing MO HealthNet to reimburse ground ambulance providers for transports to Behavioral Health Crisis Centers (BHCCs) for patients with mental health or substance use disorder diagnoses in behavioral crisis. Billing teams must update systems to use specific HCPCS ambulance codes with modifier SD and place of service code 53, and ensure ambulance trip tickets are maintained.
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What to do
by Dec 31, 2025 · 7 steps
01Billing team must update billing software to enable claims submission for ambulance transports to BHCCs using HCPCS codes A0426, A0427, A0428, A0429, and A0433 with modifier SD and place of service code 53.
02Ground mileage must be billed with A0425 (no modifier, POS 53).
03Ambulance providers must ensure all BHCC transport trip tickets are completed and maintained in medical records.
04Verify each claim includes the appropriate procedure code, modifier, and POS code per the policy requirements.
05Failure to use correct modifiers and POS codes will result in claim denials.
06Contact Provider Communications at (833) 222-7916 with questions.
07For Managed Care plans, confirm coverage requirements directly with each MC health plan as prior authorization may be required.
Codes mentioned
A0426A0427A0428A0429A0433A0425
Original notice
CMS Approves Ground Ambulance Transport to Behavioral Health Crisis Centers (BHCCs) State Plan Amendment (SPA)
mydss.mo.gov · Always check the source before changing claims.