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Children’s Mental Health Clinical Care Consultation

Revised: 04-25-2017

  • Overview
  • Eligible Providers
  • Eligible Recipients
  • Covered Services
  • Noncovered Services
  • Authorization
  • Billing
  • Legal References
  • Overview

    Mental health clinical care consultation is communication between a treating mental health professional and other providers or educators, who are working with the same recipient. These professionals use the consultation to discuss the following:

  • • Issues about the recipient's symptoms
  • • Strategies for effective engagement, care and intervention needs
  • • Treatment expectations across service settings
  • • Clinical service components provided to the recipient and family
  • In addition to the information in this section, refer to Clinical Care Consultation Frequently Asked Questions

    Eligible Providers

    Any of the following may provide mental health clinical care consultation:

  • Clinical nurse specialist in mental health (CNS)
  • Licensed independent clinical social worker (LICSW)
  • Licensed marriage and family therapist (LMFT)
  • Licensed professional clinical counselor (LPCC)
  • Licensed psychologist (LP)
  • Psychiatric nurse practitioner (NP)
  • • Psychiatrist or osteopathic physician
  • • Tribal mental health professional
  • • Mental health practitioners working as clinical trainees
  • Eligible Recipients

    To be eligible for mental health clinical care consultation, MHCP recipients must meet the following:

  • • Be between the ages of 0-21
  • • Have a diagnosis of mental illness determined by a diagnostic assessment that includes both of the following:
  • • Meets the definition of complex, as defined in the Minnesota Rules 9505.0372, Subpart 1, C, or co-occurs with other complex and chronic health conditions
  • • Requires consultation to other providers working with the child to effectively treat the condition
  • Covered Services

    MHCP covers mental health clinical care consultation between the treating mental health professional and another provider or educator. Examples of appropriate providers and educators who may receive a consultation include the following:

  • • Home health care agencies
  • • Child care providers
  • • Children’s mental health case managers
  • • Educators
  • • Probation agents
  • • Adoption or guardianship workers
  • • Guardians ad litem
  • • Child protection workers
  • • Pediatricians
  • • Nurses
  • • After-school program staff
  • • Mentors
  • Two mental health professionals treating the same client may consult; however, they need to split the time into two billable amounts comprising the total amount of time.

    Mental health clinical care consultation may be done by telephone or face-to-face.

    Documentation of Covered Services

    Medical Necessity
    Document the medical necessity for mental health clinical care consultation in the diagnostic assessment. The diagnostic assessment must describe how the child meets criteria for a complex mental health condition or which complex or chronic health conditions co-occur with the child’s mental health condition. This description may be included in the initial assessment, in an addendum to the diagnostic assessment, or within the narrative portion of the individualized treatment plan (ITP) review process. Submit this information with any request for authorization.

    Individualized Treatment Plan
    Document in the ITP the specific interventions, describing how the mental health professionals will use mental health clinical care consultation to treat the child’s mental illness.

    Progress Notes
    Document all mental health clinical care consultation in progress notes, including the following information:

  • • Mode of performance (phone or face-to-face)
  • • Date of service
  • • Start and stop time of service
  • • Intervention
  • • Person consulted (name, position, relationship to recipient)
  • • Reason for consultation
  • • Plan and action for next steps
  • • Date documented in the client’s record
  • For consultations performed by clinical trainees, the clinical supervisor must review and approve the recipient’s progress notes according to the clinical trainee’s supervision plan.

    Noncovered Services

    Mental health clinical care consultation does not include the following:

  • Communication between the treating mental health professional and a person under the clinical supervision of the treating mental health professional
  • Written communication between providers
  • Reporting, charting and record keeping (These activities are the responsibility of the provider)
  • Mental health services not related to the recipient’s diagnosis or treatment for mental illness
  • • Communication provided during the performance of any of the following mental health services:
  • • Mental health case management
  • • In-reach services
  • • Youth ACT
  • • Intensive treatment services in foster care.
  • Authorization Requirements

    MHCP will authorize clinical care consultation in units of time. Refer to the table in the Billing section.

    Refer to the Authorization section of the MHCP Provider Manual for general authorization policy and procedures. Submit the following as part of the authorization process for continuation of services:

  • • Copy of the most current diagnostic assessment
  • • Individual treatment plan that includes the following:
  • • Measurable and observable goals
  • • Start and end dates
  • • Progress notes that include the following:
  • • Mode of performance (that is, by phone or in person)
  • • Date of service
  • • Start and stop time of service
  • • Intervention
  • • Name and position of person consulted and relationship to client
  • • Reason for consultation with the individual
  • • Plan and action for next steps
  • • Date documentation was made in the client’s record
  • • Other elements that may apply, including the following:
  • • Current risk factors the recipient may be experiencing
  • • Emergency interventions
  • • Consultations with or referrals to other professionals
  • • Summary of effectiveness of treatment, prognosis, discharge planning, etc.
  • • Test results and medications
  • • Symptoms
  • Billing

  • • Enter the treating provider NPI number on each claim line
  • • Submit one claim line per day for each service (Add up all the minutes of service provided for face-to-face or non-face-to-face services for each client for that day and submit a single claim regardless of the number of consultations)
  • • Use modifier U4 for non-face-to-face service
  • Use the following table for billing services with a date of service on or after January 1, 2015:

    Clinical care consultation billing information

    Procedure Code


    Brief Description


    Service Limitations



    Clinical care consultation, face-to-face

    5 to 10 min.

    Calendar year threshold, 15 hours.

    Upper limit of timed unit to be counted to the threshold.



    Clinical care consultation, face-to-face

    11 to 20 min.



    Clinical care consultation, face-to-face

    21 to 30 min.



    Clinical care consultation, face-to-face

    31 min. and above

    Legal References

    Minnesota Rule 9505.0371 Medical Assistance Coverage Requirements for Outpatient Mental Health Services
    Minnesota Statutes 256B.0625
    , sub.62 Covered Services, Mental health clinical care consultation

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