MedicaidBilling CodesHigh impact
Herceptin Billing Policy Change
Missouri Medicaid (MO HealthNet)·MO · Oncology, Hematology·Provider Notice
Effective date
Apr 1, 2023
We identified it
Jun 20, 2026
Summary
MO HealthNet is changing how Herceptin must be billed - providers must now bill by whole vials instead of milligrams. Claims billed by milligram will no longer be paid, and partial vials are not allowed.
Action Required
Before April 1, 2023: Billing team must update system to bill Herceptin by whole vials instead of milligrams. Update billing software rules to prevent partial vial billing. Train staff that MO HealthNet claims will be denied if billed by milligram after April 1st.