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Mental Health Medication Management

Revised: 09-20-2016

Overview

"Medication management" means a service that determines the need for or effectiveness of the medication prescribed for the treatment of a client's symptoms of a mental illness.

Eligible Providers

Providers must be licensed practitioners or professionals working within the scope of their licensure.

The determination or evaluation of the effectiveness of a client's prescribed drug must be carried out by a physician or by an advanced practice registered nurse who is qualified in psychiatric nursing.

Covered Services

Mental health medication management is covered if prescribed by a licensed practitioner and dispensed by a licensed pharmacist, by a physician enrolled in the Medical Assistance program as a dispensing physician, or by a physician, physician assistant or a nurse practitioner.

Billing

Follow these guidelines when billing medication management services:

  • • If you provide psychotherapy in addition to medication management, use the appropriate evaluation and management (E/M) with psychotherapy add-on code. Refer to Psychotherapy
  • • For concurrent provision of medication management with all other services, follow NCCI (National Correct Coding Initiative) and CPT guidelines
  • • Teaching hospitals may enter the GC modifier for services performed under the direction of a supervising physician
  • • Eligible providers must use the appropriate E/M codes to bill medication management. MHCP follows current procedural technology CPT guidelines for E/M services. Follow guidelines for E/M services within the provider’s scope of practice for medication management
  • • Registered Nurses may only bill using E/M codes
  • Use the following table for billing services:

    Code

    Brief Description

    Service Limitations

    E/M

    Evaluation and medication management by registered nurse

    For medication monitoring services only, do not use modifiers

    Legal Reference

    Minnesota Rules, 9505.0370, subp., 16: Medication Management definition
    Minnesota Rules, 9505.0371, subd. 7: Individual Treatment Plan

    Minnesota Rules, 9505.0372 subp., 7: Medication management service

    Minnesota Statutes, sections 148.71 to 148.285

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    Updated: 9/20/16 8:15 AM | Accessibility | Terms/Policy | Contact DHS | Top of Page | Updated: 9/20/16 8:15 AM