MedicaidBilling CodesHigh impact
Outpatient Observation Billing
Missouri Medicaid (MO HealthNet)·MO · Emergency Medicine·Provider Notice
Effective date
Apr 29, 2024
We identified it
Jun 20, 2026
Summary
Missouri Medicaid (MO HealthNet) updated outpatient observation billing requirements, limiting reimbursement to maximum 24 hours using code G0378 on UB-04 forms. After 24 hours, additional observation time cannot be billed, but diagnostic/procedural services require separate claims with prior authorization.
Action Required
Immediately: Hospital billing teams must update UB-04 claim submission procedures for Missouri Medicaid observation cases. Use revenue code 0762 with G0378 for up to 24 hours only, rounding to nearest hour. Stop billing G0379 (direct admit to observation) as it's non-payable. For stays exceeding 24 hours, submit separate claims for diagnostic/procedural services with required prior authorizations. Update billing system to prevent submission of observation hours beyond 24-hour limit to avoid claim denials.