MedicaidDocumentationMedium impact
Clarification Regarding Providers’ Use of the Diagnostic Manual When Assessing Children Under the Age of Six (6)
Missouri Medicaid (MO HealthNet)·MO · Psychiatry, Pediatrics·Provider Notice
Effective date
Sep 1, 2026
We identified it
Sep 2, 2026
Summary
MO HealthNet (MHD) now recommends that behavioral health counseling and psychotherapy providers use DC:0-5™ for assessing children under age 6, with DSM-5-TR™ allowed until January 1, 2029. This policy applies only to behavioral health specialists, not pediatricians or family practice physicians. Billing teams must ensure claims from behavioral health providers reflect the correct diagnostic manual used.
Action Required
By January 1, 2029: Behavioral health providers must transition all child assessments (ages 0-5) from DSM-5-TR™ to DC:0-5™. Billing team should: (1) Update claim submission notes to verify which diagnostic manual was used for children under 6; (2) Flag any DSM-5-TR™ diagnoses for children 0-5 submitted after January 1, 2029 as non-compliant; (3) Communicate transition deadline to all behavioral health counselors and psychotherapists; (4) Review encounter documentation templates to ensure providers document which diagnostic manual was used. Until the 2029 deadline, both manuals are acceptable. Claims submitted after January 1, 2029 using DSM-5-TR™ for children 0-5 may be denied by MHD. For questions, contact MHD.Education@dss.mo.gov.