MedicaidCoverageMedium impact
Placement of Amniotic Membrane on the Ocular Surface; Without Sutures Coverage in the Optical Program
Missouri Medicaid (MO HealthNet)·MO · Ophthalmology, Optometry·Provider Bulletin
Effective date
Aug 14, 2026
We identified it
Sep 2, 2026
Summary
MO HealthNet now covers CPT code 65778 (Placement of Amniotic Membrane on the Ocular Surface; Without Sutures) in the Optical Program, effective August 14, 2026. The service requires pre-certification through CyberAccess and is only eligible for participants with qualifying ocular diagnoses and documented failed alternative therapies. Reimbursement rates are $1,034.55 for unilateral and $1,551.83 for bilateral procedures.
Action Required
By August 14, 2026: (1) Billing team must update billing system to recognize CPT 65778 as a covered procedure in the MO HealthNet Optical Program with applicable reimbursement rates ($1,034.55 unilateral / $1,551.83 bilateral with modifier 50). (2) Establish workflow requiring pre-certification via CyberAccess (call 800-392-8030 Option 2 or use CyberAccess portal) before scheduling or billing this procedure. (3) Add pre-certification requirement to encounter forms and provider workflow. (4) Verify patient eligibility on date of service via eMOMED or call Provider Communications at (833) 222-7916. (5) Ensure providers document qualifying ocular diagnosis and history of failed alternative therapies per Optical Pre-Certification Document. (6) Claims submitted without approved pre-certification will be denied.