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AmbetterExchange · Documentation · Claims & Billing · MO · Critical Care, Geriatrics, Internal Medicine +2 moreHigh impact

Malnutrition Policy Provider Notification - Effective 10.1.2026 (PDF)

Act
by Oct 15, 2026
Effective date
Oct 15, 2026
Identified
Aug 26, 2026

Summary

Home State Health is updating its Malnutrition Policy (CP.PP.145) effective October 15, 2026, to expand documentation requirements for inpatient malnutrition diagnoses. The policy now distinguishes between moderate (non-severe) malnutrition (ICD-10 E44.0) and severe malnutrition (ICD-10 E44.1), requiring specific physician documentation. Claims billed with malnutrition as a major complication/comorbidity (MCC) that lack proper documentation will be denied reimbursement.

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What to do

by Oct 15, 2026 · 4 steps
01Billing team must implement retrospective claim review processes for all inpatient claims containing ICD-10 codes E44.0 (moderate malnutrition) or E44.1 (severe malnutrition) as MCC diagnoses.
02Update claim submission guidelines to require providers to document malnutrition diagnosis with specific clinical details per the revised criteria.
03Establish denial processes for claims with malnutrition coding that lack physician documentation supporting the diagnosis severity and medical necessity.
04Educate hospital billing staff and provider documentation teams on the distinction between moderate and severe malnutrition coding requirements.
If missed: Failure to comply will result in claim denials and potential DRG payment adjustments retroactively.

Codes mentioned

E44.0E44.1

Original notice

Malnutrition Policy Provider Notification - Effective 10.1.2026 (PDF)
ambetterhealth.com · Always check the source before changing claims.
View original ↗

Related changes

See all Ambetter changes →
Payment Policy CP.PP.145 MalnutritionMediumEffective Jan 1, 2027 · Claims & BillingUpdate for Malnutrition CP.PP.145: Effective November 1, 2026HighEffective Nov 1, 2026 · Provider BulletinPayment & Clinical Policies Effective Sept 1, 2026HighEffective Sep 1, 2026 · Claims & BillingMalnutrition Policy Revision Policy: Effective September 1, 2026HighEffective Sep 1, 2026 · Provider BulletinBrowse every Ambetter change in the policy list

Related policy hubs

Ambetter policiesMO policy changesCritical CareGeriatricsInternal MedicinePalliative CareGeneral SurgeryCode E44.0Code E44.1

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