MedicaidCoverageMedium impact
CPT 65778 in Optical Program
Missouri Medicaid (MO HealthNet)·MO · Ophthalmology, Optometry·Coding
Effective date
Aug 14, 2026
We identified it
Aug 20, 2026
Summary
Effective August 14, 2026, MO HealthNet now covers CPT 65778 (Placement of Amniotic Membrane on the Ocular Surface; Without Sutures) in the Optical Program for eligible participants with qualifying ocular diagnoses and documented failed alternative therapies. This service requires pre-certification through CyberAccess before delivery, with reimbursement rates of $1,034.55 (unilateral) or $1,551.83 (bilateral with modifier 50).
Action Required
Before August 14, 2026: (1) Billing team must register for CyberAccess portal access by contacting the help desk at (888) 581-9797, (573) 632-9797, or emailing CyberAccessHelpdesk@conduent.com to enable pre-certification submission. (2) Update billing system to require pre-certification for CPT 65778 before service delivery. (3) Add CPT 65778 to fee schedule with rates of $1,034.55 (unilateral) and $1,551.83 (bilateral with modifier 50). (4) Train providers and front desk staff that this procedure requires: pre-certification via CyberAccess, verification of MO HealthNet eligibility on date of service (call (888) 222-7916 or use eMOMED), and documentation of qualifying ocular diagnosis with history of failed alternative therapies. (5) Update encounter forms and clinical documentation templates to capture medical necessity criteria. Claims submitted without pre-certification will be denied; approved pre-certification does not guarantee payment without active MO HealthNet eligibility verification.