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COMPLEMENTARY ANDALTERNATIVE THERAPIESFOR CHRONIC PAINMANAGEMENT1REVISED AUGUST 2019
COMPLEMENTARY AND ALTERNATIVE THERAPIESFOR CHRONIC PAIN MANAGEMENTEFFECTIVE FOR DATES OF SERVICE APRIL 1, 2019 MO HealthNet is implementing statewidecomplementary health and alternative therapyservices for chronic pain management.Evidence has shown that utilization ofcomplementary and alternative therapies forchronic pain management leads to betterhealth outcomes in the adult population.2
COMPLEMENTARY AND ALTERNATIVE THERAPIESFOR CHRONIC PAIN MANAGEMENT 3The intent of these services is to provide complementary andalternative therapy, coordinated by the primary careprovider, in an effort to provide alternatives to opioid use forthe treatment of chronic pain, reduce opioid misuse,improve MO HealthNet participants’ chronic painmanagement skills, reduce avoidable costs, and improvehealth outcomes.
COMPLEMENTARY AND ALTERNATIVE THERAPIESFOR CHRONIC PAIN MANAGEMENT Complementary and alternative therapiesincludes a combination of newly coveredservices including physical therapy, chiropractictherapy, and acupuncture, along with currentcoverage of cognitive-behavioral therapy (CBT)for chronic pain and non-opioid medicationtherapy.4
Code of State Regulations (CSR)Requirements and other informationregarding complementary health andalternative therapies for chronic painmanagement services can be found at13 CSR 70-3.300.5
Clarification on Chiropractic Services6 The MO General Assembly voted to include chiropractic services as acovered MO HealthNet service in August 2018. The program was notfunded. Currently MHD is awaiting appropriations. A provider bulletinwill be posted outlining program benefits, limitations and providerenrollment information. The Complementary and Alternative Therapies for Chronic PainManagement program will encompass those procedure codesoutlined in the Provider Bulletin for chiropractic services.
PARTICIPANT ELIGIBILITY7For participants to be eligible for complementary and alternative therapy services theindividual must meet the following criteria: be MO HealthNet eligible; and be 21 years of age or older, and have one of the following conditions: chronic, non-cancer neck and/or back pain; or chronic pain post traumatic injury such as traumatic injury resulting from a motor vehicle collision; andhave a qualifying chronic pain diagnosis as determined by MO HealthNet Division.
Managed Care Participants Participants enrolled in a managed care health planwill receive complementary and alternative therapyservices through their managed care organizationeffective April 1, 2019. Questions regarding MO HealthNet Managed Carebenefits should be directed to the patient’s MOHealthNet Managed Care health plan.8
Provider Qualifications Providers of complementary and alternative therapyservices must be currently enrolled with MO HealthNet. Complementary and alternative therapy providers willbill under the Complementary and/or Alternativetherapy provider type with a Complementary and/orAlternative therapy specialty.9
10Provider TypesPT 23 ChiropractorCan be both billing & performingprovider.Chiropractic therapy for thetreatment of chronic pain mayinclude, but is not limited to,spinal manipulation or spinaladjustment, and as furtherdefined by section 331.010.1,RSMoPT 72 AcupunctureCan be both billing &performing provider.Acupuncture involvesthe use of needlesinserted into the bodyby piercing of theskin and othermodalities as definedby sections 331.030.8and 324.475(1),RSMo.PT 48 Physical TherapistCan be both billing &performing provider.Physical therapy treatmentfor chronic pain includes,but is not limited toparticipant education andcounseling, manualtechniques, therapeuticexercises, electrotherapy,and massage.
COGNITIVE BEHAVIORAL THERAPY MHD enrolled behavioral health providers may deliver CBT via individual,family, or group modalities and may report either psychotherapy codes(90832-90853) or health and behavior assessment and intervention codes(96150-96154). Individual (90832, 90834, 90837), family (90846, 90847), and group psychotherapy (90853) require precertificationand may be provided for diagnosis codes of F45.41 and F45.42. Healthand behavior assessment and intervention services do not requireprecertification and may be provided for physical health conditions. Foradditional information about these services, refer to the Behavioral HealthServices Manual athttp://manuals.momed.com/collections/collection psy/print.pdf11
Physicians billing for Acupuncture12 Acupuncturecertified MO HealthNet enrolledphysicians can bill for appropriate acupuncture codes. Toenroll as a provider of acupuncture services forcomplementary health and alternative therapy servicesfor chronic pain, an individual must have and maintainstate licensure as an acupuncturist or be licensed as aphysician in the state of Missouri and be credentialed toperform acupuncture
Benefit Limits Theannual limit of complementary andalternative therapy services will notexceed an allowable maximum of thirty(30) visits or one hundred twenty (120)units per “rolling” year with one (1) unitequaling fifteen (15) minutes.13
Cognitive Behavior Therapy CBTwill not be included inthe “combination.” No restriction on group orindividual therapy14
Pre-Certification Physical therapy, chiropractic therapy and acupuncturist’sservices covered as complementary and alternativetherapies for chronic pain management as described inthis bulletin require pre-certification. Pre-certification of physical therapy, chiropractic therapyand acupuncturist’s services is a two-step process.Requests for pre-certification must be initiated by a MOHealthNet enrolled physician who prescribes the service inthe participant’s plan of care.15
Pre-Certification (cont.)16 The enrolled physical therapy, chiropractic therapy or acupuncture service providerwho will perform the service will access the pre-certification initiated by the prescribingphysician to complete the second step of the pre-certification process CyberAccess is a web-based tool that allows physicians to prescribe electronically, viewdiagnosis data, receive alerts, and select appropriate preferred medications, andelectronically request drug and medical prior authorizations for their MO HealthNet patients. The MO HealthNet division contracts with Conduent to provide CyberAccesssm. To become a CyberAccesssm user, contact the Conduent help desk at: 888-581-9797 or 573-632-9797or send an email CyberAccesshelpdesk@conduent.com
17Pre-certificationscan be obtainedby calling:800-392-8030option 6
Please Note:An approved pre-certification request does notguarantee payment. The provider must verifyparticipant eligibility on the date of service usingthe Interactive Voice Response (IVR) System at(573) 635-8908 or by logging onto the MOHealthNet Internet Web portal at:www.emomed.com18
Provider Enrollment If a qualified provider is already enrolled with MO HealthNet Division, aProvider Update Request form should be submitted to the MissouriMedicaid Audit & Compliance (MMAC) Provider Enrollment Unit (PEU).The provider must complete Sections I and II on the Provider UpdateRequest form and enter the specialty code that matches your title inSection IV. The Provider Update Request form is available at: 13/11/ProviderUpdate-Request-Form.pdf19
Provider Enrollment InformationChiropractors currently can enroll as aQualified Medicare Beneficiary (QMB)provider. However, if Chiropractors wishto enroll under the new, alternativetherapy provider type they will need todo one of the following:20 Dis-enroll their currently enrollednumber Enroll with a new National ProviderIdentifier (NPI) Enroll with a taxonomy code to keepthe same NPI for both the QMBprovider type and the new providertype.If a qualified provider is not already enrolled with MO HealthNet Division as aprovider, an enrollment application must be submitted. The link to complete theelectronic application ommongui/PeHome.jspFor additional questions regarding provider enrollment email:mmac.providerenrollment@dss.mo.gov
POWER POINT POSTED AT:21 MOHealthNet Provider InformationPage/Education/Training Email:MHD.PROVTRAIN@dss.mo.govAttention: Dana B. https://dss.mo.gov/mhd/providers/education/
22QUESTIONS?THANK YOU FOR ATTENDING THE WEBINAR
FOR CHRONIC PAIN MANAGEMENT EFFECTIVE FOR DATES OF SERVICE APRIL 1, 2019 MO HealthNet is implementing statewide . complementary health and alternative therapy services for chronic pain management. Evidence has shown that utilization of complementary and alternative therapies for chronic pain management leads to better
