MedicaidBilling CodesMedium impact
Outpatient Hospital Facility Charges
Missouri Medicaid (MO HealthNet)·MO·Provider Notice
Effective date
Apr 13, 2017
We identified it
Jun 20, 2026
Summary
MO HealthNet has clarified billing rules for outpatient hospital facility charges, specifying when facility charges are appropriate versus when specific procedure codes should be used instead. Inappropriate billing will result in payment recoupment.
Action Required
Immediately: Billing team must review all outpatient hospital facility charge billing practices to ensure compliance with MO HealthNet guidelines. Stop billing facility charges for standalone services like PT/OT, dialysis, injections, lab, and radiology - use appropriate CPT/HCPCS codes instead. Only bill one facility code per date of service, combining charges if multiple physicians are seen. Failure to comply will result in payment recoupment.