MedicaidBilling CodesHigh impact
COVID-19: Valid ICD-10 Diagnosis Code on Pharmacy Claims - Updated
Missouri Medicaid (MO HealthNet)·MO·Pharmacy
Effective date
Aug 16, 2020
We identified it
Jun 20, 2026
Summary
MO HealthNet Division now requires ICD-10 diagnosis codes on pharmacy claims and will deny claims if codes lack proper specificity. Pharmacies must use the most specific billable codes (e.g., F20.0 instead of F20) and enter codes without periods in their point of sale systems.
Action Required
Immediately: Billing team must ensure all pharmacy claims include ICD-10 diagnosis codes at highest specificity level. Update pharmacy point of sale software to enter diagnosis codes without periods (e.g., F200 not F20.0). Verify all diagnosis codes are billable before submission. Obtain exact diagnosis codes from prescribing providers. Claims may be denied if diagnosis codes lack full specificity or are non-billable.