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MO HealthNet Internet Provider Training Program Presented by the Provider Education Unit

Learn about reimbursement for multiple surgical procedures, claim submission guidelines, and exceptions. Contact Provider Education Unit for questions.

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MO HealthNet Internet Provider Training Program Presented by the Provider Education Unit

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  1. MO HealthNet Internet Provider Training Program Presented by the Provider Education Unit MO HealthNet Division MO HealthNet Division

  2. MULTIPLE SURGICAL PROCEDURES Presented by the Provider Education Unit MO HealthNet Division MO HealthNet Division

  3. Information regarding multiple surgical procedures can be found in Section 13.40.F of the Physician Provider Manual. To access the manual go to the MHD Public Web site www.dss.mo.gov/mhd/providers/index.htm. In the left hand column, click on Provider Manuals. MO HealthNet Division

  4. When multiple surgical procedures are performed for the same body system through the same incision, the major procedure is considered for reimbursement at 100% of the allowable fee for the procedure. MO HealthNet Division

  5. Multiple surgical procedures performed on the same participant, on the same date of service, by the same provider, for the same or separate body system through separate incisions must be billed as follows: • The major, secondary and tertiary procedures should be indicated on the claim form using appropriate CPT codes. MO HealthNet Division

  6. A copy of the Operative Report must be attached to the paper claim for multiple surgeries to provide additional information and to assist in the reimbursement process. MO HealthNet Division

  7. Claims for multiple surgeries are allowed according to the following: • 100% of the allowable fee for the major procedure • 50% of the allowable fee for the secondary procedure • 25% of the allowable fee for each additional procedure MO HealthNet Division

  8. An exception to the multiple surgical procedure policy is diagnostic endoscopies. When more than one diagnostic endoscopy is performed on the same day with the same or different approaches, but different instruments, both are reimbursable at 100% of the allowable fee for the procedure. MO HealthNet Division

  9. When more than one diagnostic endoscopy is performed on the same day using the same approach and the same instrument, only the major procedure is reimbursable. MO HealthNet Division

  10. Thank you again for participating in this training program. If you have questions regarding the information in this presentation, please contact the Provider Education Unit at 573-751-6683. MO HealthNet Division

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