MedicaidCoverageHigh impact
Physical Therapy
Missouri Medicaid (MO HealthNet)·MO · Physical Therapy, Pain Management·Provider Notice
Effective date
Jul 1, 2026
We identified it
Sep 2, 2026
Summary
Effective July 1, 2026, physical therapy services for adults are no longer covered through Missouri's Complementary Health and Alternative to Chronic Pain Management Program. However, PT remains covered for pediatric patients (age 0-20), pregnant women, blind individuals, and residents of skilled nursing facilities. Billing teams must identify patient eligibility and deny or redirect claims for non-qualifying adult patients.
Action Required
By June 30, 2026: Billing team must update system logic to verify patient eligibility before processing physical therapy claims for Missouri Medicaid. Implement checks for: (1) patient age (deny adult PT claims unless age 0-20), (2) pregnancy/blind status documentation, (3) skilled nursing facility placement. Update encounter forms and patient intake to capture these eligibility criteria. Train front desk and billing staff on new screening requirements. Beginning July 1, 2026, deny all adult physical therapy claims that do not meet exception criteria, and notify providers and patients of coverage loss with referral to alternative pain management options. Failure to implement eligibility verification will result in claim rejections and compliance issues with Missouri Medicaid.