MO HealthNet Hospice Provider Manual § 1.2

Under a fee system each procedure, service, medical supply, and equipment covered under a specific program has a maximum allowable fee established.

In determining what this fee should be, MHD uses the following guidelines:

Recommendations from the State Medical Consultant and/or the provider subcommittee of the Medical Advisory Committee

Medicare’s allowable reasonable and customary charge payment or cost-related payment, if applicable

Charge information obtained from providers in different areas of the state. Charges refer to the usual and customary fees for various services that are charged to the general public. Implicit in the use of charges as the basis for fees is the objective that charges for services be related to the cost of providing the services

MHD then determines a maximum allowable fee for the service based upon the recommendations, charge information reviewed and current appropriated funds.

Payment for hospice services is made to a designated hospice provider based on the hospice rates published annually by the Centers for Medicare & Medicaid Services (CMS). These hospice rates are effective from October 1 of each year through September 30 of the following year. MHD publishes a provider information Bulletin annually with the hospice rates in effect for the current year. Providers should subscribe to MO HealthNet News to be notified of the Bulletin each year.

Fee Schedule

The MO HealthNet Fee Schedule identifies covered and non-covered procedure codes, restrictions, allowed units, and the MO HealthNet allowable fee per unit.

The Fee Schedule is updated monthly and is intended as a reference not a guarantee for payment.

The Fee Schedule allows for the downloading of individual files or the search for a specific fee schedule. Some procedure codes may be billed by multiple provider types. Categories within the Fee Schedule are set up by the service rendered and are not necessarily provider specific.