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MHCP Provider Manual

Latest Manual Revisions

Revised: 02-13-2018

Updates cited below do not include minor grammatical or formatting changes that otherwise do not have bearing on the meaning of the policy contained herein. Refer to Provider Updates that may contain additional MHCP coverage policies or billing procedures. MHCP incorporates information from these updates into the Provider Manual on an ongoing basis. Sign up to get email notices of section changes.

February 2018

02-13-2018
Addition(s)/Revisions

Physician and Professional ServicesClarified in NDC Reporting of Outpatient Physician-Administered Compound Drug subsection that multiple service lines are necessary.

Added public health nursing organization to eligible providers for telemedicine.

Under Transplant Services:

  • • Clarified eligible providers and moved stem cell information to the Stem Cell Transplant Coverage subsection.
  • • In Eligible Recipients, clarified that people enrolled in emergency Medical Assistance are eligible for kidney transplants when the transplant is approved thorough an EMA Care Plan Certification, but EMA does not cover any other organ transplants.
  • • Clarified other transplant coverage as required to be performed in a Medicare certified transplant facility.
  • 02-12-2018
    Addition(s)/Revisions

    Equipment and Supplies

  • Hospital Beds – Changed "safety beds" to "enclosed beds."
  • 02-09-2018
    Addition(s)/Revisions

    Dental Services

  • Children and Pregnant Women – Services performed in a school or Head Start program are considered house calls. House calls or extended-care facility calls can only be billed for on-sight delivery of covered services.
  • Non-Pregnant Adults – Under Covered Services, the following codes were discontinued and replaced with new codes effective January 1, 2018:
  • • D5510 (replaced with D5511 and D5512)
  • • D5610 (replaced with D5611 and D5612)
  • • D5620 (replaced with D5621 and D5622)
  • 02-07-2018
    Addition(s)/Revisions

    Provider Basics
    Programs and Services

  • • Revised program descriptions in the major program codes chart to reflect current coverage groups in each program.
  • • Revised description of automatic newborn coverage to indicate the exact programs the policy applies to.
  • • Revised description of spenddowns to indicate the exact programs the policy applies to.
  • 02-06-2018
    Addition(s)/Revisions

    Anesthesia Services – Added the 2018 anesthesia rates chart.

    02-02-2018
    Addition(s)/Revisions

    Individualized Education Program (IEP) Services

  • Record Keeping and Documentation – We clarified under the Service Time and Encounters section that when two providers are working with the same child at the same time, report only the face-to-face time providing services to the child. Overlapping time or waiting while the other provider is working with the child is considered indirect time.
  • 02-01-2018
    Addition(s)/Revisions

    Transportation Services

  • Local County or Tribal Agency Nonemergency Medical Transportation (NEMT) Services Claim, Service, and Rate Information – We updated the local agency volunteer and licensed foster parent rates for 2018.
  • January 2018

    01-31-2018
    Addition(s)/Revisions

    Individualized Education Program (IEP) Services

  • IEP Rates and Payments – We removed information about coverage for IEP evaluations, re-evaluations and assessments under the Reporting Cost Data – District Responsibilities section, and inserted a link to that information under Covered and Noncovered Services in the IEP Services Manual.
  • 01-30-2018
    Addition(s)/Revisions

    Provider Basics
    Billing Policy (Overview)

  • Billing the Recipient – Added table for 2018 copays and family deductible and updated throughout that the family deductible increased to $3.15 effective Jan. 1, 2018.
  • Equipment and Supplies

  • • Under Covered Services, we added information on the 21st Century Cures Act effective January 1, 2018, regarding the Medicare upper payment limit for MHCP durable medical equipment.
  • • Under Miscellaneous Products, Sharps Disposal Containers, we added that an attachment is required for Medicare claims.
  • • Under Billing and Documentation, Add-ons and Upgrades, current language stated the provider cannot bill the member for the difference of the covered equipment and the upgraded equipment. We clarified that the provider cannot bill the member or accept payment on behalf of the member for the difference between the covered equipment and the upgraded equipment.
  • • Under Fixed height manual hospital beds, protection from serious injury has been added as a criteria for coverage.
  • • Under Bariatric, extra-duty, extra wide hospital beds, the following language has been added:
  • • Coverage may be considered for members with daily seizure activity, uncontrolled movement disorder, or a medically necessary condition putting the member at significant risk for injury in a standard bed. Requests for a manual, semi-electric, or total electric bed must meet the criteria for the type of hospital bed requested.
  • • Under Pediatric hospital beds, pediatric-sized hospital beds have been defined with footboard and side rails up to 24 inches above the spring.
  • • Bed Enclosure and enclosed beds have been replaced with Safety Beds. The requirement of unrestricted mobility resulting in documented injuries sustained as a result of wandering unsupervised has been removed and replaced with unrestricted mobility demonstrates significant risk for serious injury, not just possibility of injury.
  • • Under Authorization, documentation requirements for requests for bariatric/heavy duty hospital beds, has been added for members with daily seizures, uncontrolled movement disorder, or a medically necessary condition.
  • Seasonal Affective Disorder (SAD) Lights – We clarified that therapeutic light boxes are covered when referred by an MHCP enrolled mental health practitioner. When billing with an approved authorization, enter the physician as the ordering provider.
  • 01-26-2018
    Addition(s)/Revisions

    Behavioral Health Home Services – We added updates to billing requirement and guidance on billing for other MA-covered services.

    Individualized Education Program (IEP) Services

  • Record Keeping and Documentation – We added clarification to the start and end times requirement that will be implemented starting February 1, 2018.
  • Provider Requirements

  • Access Services – Under Eligible Providers, we deleted community health workers in the subsection "Ineligible for interpreter services." Interpreter services are now available when receiving community health worker services.
  • 01-25-2018
    Addition(s)/Revisions

    Hospital Services

  • Critical Access Hospital (CAH) Services - We updated the Critical Access Hospital (CAH) manual page with new rebase rate information for CAH services. The updates are made in the following sections:
  • Payments beginning with your fiscal year ending in 2017
  • Cost-based inpatient payment methodology for CAH
  • Individualized Education Program (IEP) Services

  • Personal Care Assistance (PCA) Services – We clarified and added information about the use of start and end times for PCA services in school and how to document information for time studies.
  • Rates and Payments – We added clarification of the new start and end time requirements.
  • 01-23-2018
    Addition(s)/Revisions

    HCBS Waiver Services – We updated the Covered and Noncovered Services grid to reflect the added services to BI, CAC, CAD, and DD waivers:

  • • Case management aide (DD)
  • • Crisis respite (CAC)
  • • Night supervision (CAC and DD)
  • • Specialist services (BI, CAC and CADI)
  • 01-19-2018
    Addition(s)/Revisions

    Community Health Worker (CHW) – Added registered nurse to the list of providers that can supervise a CHW and added language to allow CHWs to enroll using an NPI if they have one under Covered Services.

    Early Intensive Developmental and Behavioral Intervention (EIDBI) Benefit

  • Early Intensive Developmental and Behavioral Intervention (EIDBI) Provider Enrollment – Added updates to Telemedicine section to include enrollment for the mental health practitioner to provide the service. Added section for the mental health professional supervisor to enroll in order to supervise a clinical trainee completing the CMDE. Clarified language related to enrollment for the provider agency.
  • Mental Health Services

  • Psychotherapy – Under the Billing section we added effective Jan. 1, 2018, psychotherapy add-on code 99354 will be allowed for billing with code 90847 family psychotherapy. Use prolonged service code 99354 with 90847 to report Family Psychotherapy face-to-face with recipient present of 80 minutes or longer. 99354 will count towards the cumulative calendar year threshold of 26 sessions. We also updated individual psychotherapy code description to match CPT 2017 description and with patient or family present was removed.
  • 01-12-2018
    Addition(s)/Revisions

    Early Intensive Developmental and Behavioral Intervention (EIDBI) Benefit – We made the following changes to the section:

  • • Updated link to EIDBI state plan under Legal References.
  • • Added clarification on the authorization requirements for the initial ITP, CMDE and coordinated care conference under the Service Authorization section.
  • • Added language under Billing that DHS will not accept claims for services rendered by a clinical trainee at this time but enrollment applications will be accepted.
  • • Updated requirement for Level III providers to include their UMPI number for all services rendered on the claim under the Submitting Claims section.
  • • Added information about providers being required to have a MN-ITS username and password to log in to CMDE and ITP forms under the Submitting Claims section.
  • Equipment and Supplies

  • Oxygen Contract Regions and Price Schedule (PDF) – Updated pricing for the 2018 oxygen contract.
  • Immunizations & VaccinationsWe added effective for service dates on or after January 1, 2018, the base rate for vaccine administration is the lower of the provider's submitted charge or the Resource Base Relative Value Scale (RBRVS) rate under the Administering Vaccines – Billing and Payments section.

    01-10-2018
    Addition(s)/Revisions

    Early Intensive Developmental and Behavioral Intervention (EIDBI) Benefit

  • Early Intensive Developmental and Behavioral Intervention (EIDBI) Benefit Grid – We added that all service limits apply to the recipient. Also, we revised language under ITP to be one initial ITP every three years without authorization.
  • 01-04-2018
    Addition(s)/Revisions

    Moving Home Minnesota (MHM) – We updated the Disability Linkage name to Disability Hub MN under MHM Recipient Enrollment.

    01-02-2018
    Addition(s)/Revisions

    Equipment and Supplies

  • Oxygen Equipment – Removed authorization requirements for oxygen equipment. Added new coverage policy for portable concentrators, home liquefier systems, home compressor systems, and portable equipment for recipients with stationary concentrators.
  • Previous Revisions

    2017 Manual Revisions

    2016 Manual Revisions

    2015 Manual Revisions

    2014 Manual Revisions

    2013 Manual Revisions

    2012 Manual Revisions

    2011 Manual Revisions

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    © 2018 Minnesota Department of Human Services Updated: 2/13/18 11:09 AM | Accessibility | Terms/Policy | Contact DHS | Top of Page | Updated: 2/13/18 11:09 AM