High demand for addiction treatment services in recent years, and especially among Medicaid patients, means that addiction treatment billing departments must have a solid grasp on the ins and outs of billing Medicaid for addiction treatment services in Missouri. The show-me state has maintained its elevated opioid overdose rates year-over-year as more and more patients scramble to find programs with availability.
Meanwhile, as Medicaid unwinding continues, Missouri saw large swaths of the population cut from Medicaid. Half of those people were children under the age of 18. A grassroots effort is underway to reverse some of those redeterminations, but in the meantime, it's important to always verify that your patient is, indeed, current with their Medicaid coverage before beginning any treatment services.
In today’s post, we’ll cover some of the most frequently asked questions we hear about billing Medicaid for addiction treatment services in Missouri.
Where Can Addiction Treatment Patients Apply for Medicaid in Missouri?
If you have patients who need to complete a Medicaid application, you can point patients to the Universal Access portal here. You can search the MO HealthNet fee-for-service provider directory here.
What is Medicaid Called in Missouri? Does it Cover Addiction Treatment Services?
Missouri’s Medicaid program is called MO Healthnet. A special subdivision, called CSTAR or Comprehensive Substance Treatment and Rehabilitation Program, provides substance use disorder treatment services for patients at every level of care along the continuum of care.
What are the Different Addiction Treatment Programs in Missouri Called?
Missouri’s CSTAR program and several subdivisions but there are also a few more programs that Medicaid billers who work in addiction treatment might want to be familiar with.
Here’s a list of the different treatment programs you’ll encounter when billing Medicaid for SUD services in Missouri:
CSTAR
CSTAR Women and Children
CSTAR Adolescent
CSTAR General Population
CSTAR Opioid
Primary Recovery Plus
Medication Assisted Treatment
You can read more details on these various programs on the Missouri Department of Mental Health’s website.
Does Missouri Medicaid Cover Sober Living Homes?
No. In general, sober living is beyond the scope of most Medicaid programs. Room and board at residential facilities is often covered, but room and board at a sober living home or recovery residence is not covered under Missouri Medicaid.
That said, CSTAR does sometimes provide transitional living to qualified individuals. These services can be billed to Missouri Medicaid.
What are Some of the Most Common CPT Codes for Missouri Addiction Treatment Medicaid Billing?
You can access all of the CPT codes you’ll need to bill for Medicaid addiction treatment services on MO HealthNet’s Comprehensive Substance Treatment and Rehabilitation Manual.
Some of the most common CPT codes you’ll encounter with addiction treatment billing for Medicaid in Missouri are:
Intake assessment - H0001
Behavioral health assessment - H0002
Assessment and diagnostic update - H0001 52
Day treatment - H2012
Community support - H2015
Individual counseling - H0004
Co-occurring disorders individual counseling - H0004 HH
Trauma individual counseling - H0004 ST
Group counseling - H0005
Group rehabilitative support - H0025
Trauma group rehabilitative support - H0025 ST
Family therapy - office - T1006
Family conference - T1006 52
Individual collateral depending counseling - H0004 UK
Group collateral depending counseling - H0005 UK
Medication services support - T1002
Medically monitored withdrawal management - H0011
Methadone dosing - H0020
Adolescent treatment support - T2048
If you need a reminder about how CPT codes and other billing codes work, check out some of our other blog posts on this topic:
Dive Into the Top 3 CPT Codes for Addiction Treatment
Understanding HCPCS and CPT Billing Codes for Residential Addiction Treatment: H0017, H0018, H0019
Does Missouri Medicaid Cover Peer Support Services for Addiction Treatment?
Yes. The majority of states now cover peer services under their Medicaid programs and Missouri’s Medicaid program covers both peer support services and family support services. Both are also approved for telemedicine.
The procedure codes for peer support sessions are:
Peer Support ( H0038 )
Peer Support - Telemedicine ( H0038 GT )
Family Support ( H0038 HA )
Family Support - Telemedicine ( H0038 HA GT )
Want More Content on the Addiction Treatment Community in Missouri?
Review Our Other Blog Posts About Missouri:
Missouri is a Great State for Opening Your Next Addiction Treatment Center
Pros and Cons of Opening a Sober Living Home Business In Missouri
Understanding National Regulations on Sober Living Homes in the United States - Part 2
Treatment Facilities in Missouri – BEHAVE
Bill Medicaid for Addiction Treatment in Missouri the Easy Way
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