MedicaidBilling CodesHigh impact
Outpatient Drug Quantity Billing
Missouri Medicaid (MO HealthNet)·MO·Pharmacy
Effective date
Sep 26, 2017
We identified it
Jun 20, 2026
Summary
Providers must bill outpatient medications using exact quantities in specific units (ml/cc for liquids, grams for ointments, number of vials for powders) rather than per dose or per container. This affects how injectable medications, eye drops, ointments, vaccines, and combination products are billed for MHD participants.
Action Required
Immediately: Billing team must update medication billing to use exact quantities - bill liquids/injectables by ml/cc dispensed (including decimals), ointments by grams, powder vials by number of vials, eye drops by ml/cc per bottle, vaccines by ml/cc (not per dose), Herceptin by milligrams, and combination products as kits. Update billing system rules and train staff on proper quantity calculations to prevent claim denials.