MedicaidDocumentationMedium impact
Manually Priced Procedures
Missouri Medicaid (MO HealthNet)·MO·Provider Notice
Effective date
Aug 12, 2026
We identified it
Aug 13, 2026
Summary
MO HealthNet now requires invoices to be attached to claims for manually priced procedures to facilitate State Medical Consultant pricing. Procedure codes ending in '99' are identified as typically requiring manual pricing and must include necessary pricing information. Providers should reference the MO HealthNet Fee Schedule to determine which procedures require attachments.
Action Required
Effective immediately (08/12/2026): Billing team must implement the following changes: (1) Identify all procedures that require manual pricing, particularly those with codes ending in '99', by consulting the MO HealthNet Fee Schedule; (2) Update billing software to flag these procedures for invoice attachment prior to claim submission; (3) Create a checklist or workflow reminder for billing staff to obtain and attach invoices outlining materials/supplies costs for manually priced procedures; (4) Train providers and billing staff to include pertinent materials/supplies information on invoices to support State Medical Consultant pricing decisions. Consequence of inaction: Claims for manually priced procedures submitted without required invoice attachments will likely be denied or delayed for additional information requests from MO HealthNet.