MedicaidCoverageHigh impact
The 2022 - 2023 Respiratory Syncytial Virus (RSV) season is winding down
Missouri Medicaid (MO HealthNet)·MO · Pediatrics, Allergy & Immunology, Infectious Disease·Provider Notice
Effective date
Feb 28, 2023
We identified it
Jun 26, 2026
Summary
Missouri HealthNet (MHD) is ending prior authorization requirements for Synagis (RSV prophylaxis) effective February 28, 2023, and will no longer cover any Synagis doses administered after this date. This change reflects the early conclusion of the 2022-2023 RSV season in Missouri, with RSV virology positivity dropping below 3%.
Action Required
By February 28, 2023: Billing team must immediately stop submitting prior authorization requests for Synagis (J1562) to MHD. Update billing system rules to deny or flag any Synagis claims with service dates on or after February 28, 2023. Notify all providers, especially pediatrics and high-risk patient care teams, that Synagis is no longer covered by MHD after this date. Providers must cease administering Synagis doses after February 28, 2023, or claims will be denied. Contact MO HealthNet Pharmacy and Medical Pre-Certification Helpdesk at 800-392-8030 with questions.