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MHCP Provider Manual

Latest Manual Revisions

Revised: 12-07-2017

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.

December 2017

12-07-2017
Addition(s)/Revisions

Moving Home Minnesota (MHM)

  • • In the Overview we changed the age from 65 to 60 and deleted the words "minimum or prevailing wage."
  • • We clarified the required training for Moving Home Minnesota (MHM) providers to state that the Association of Community Rehabilitation Educators (ACRE) must approve the training curriculum.
  • In the Billing section, we explained the two-step process for billing for the incentive benchmark payment for supported employment and added a link to the online form Moving Home Minnesota Milestone Form (DHS-6759L)
  • 12-05-2017
    Addition(s)/Revisions

    Equipment and Supplies

  • Pressure Reducing Support Surfaces – The prior authorization requirement for Group 2 and 3 pressure reducing support surfaces has been changed from monthly to every six months.
  • Individualized Education Program (IEP) Services – Added links to services under Covered and Noncovered Services.

    Mental Health Services

  • The Mental Health Diagnostic Code Range table has been updated the diagnosis codes are effective October 1, 2016, per ICD 10 guidelines. The following changes have been made:
  • • Mental Health Diagnostic Code Ranges has been revised, removing repetitive information that appears in text and in table format.
  • • Added the following :
  • • Disorder of adult personality and behavior (F60-F68.89)
  • • Pervasive and specific developmental disorders (F80.81-F89)
  • Behavioral and emotional disorders with onset usually occurring in early childhood and adolescence (F90-F98.9)
  • 12-01-2017
    Addition(s)/Revisions

    Equipment and Supplies

  • Mobility Devices – We made the following changes to this section:
  • • Under Custom Molded and Prefabricated Custom Seating Systems, the requirement of a power wheelchair being considered in a long-term care facility only if it allows the recipient to complete most activities of daily living independently has been removed and replaced with:
  • Authorization for a power wheelchair will be considered only if it allows the recipient to experience inclusion and integration in the long-term care facility. Documentation must demonstrate the absence of a progressive condition.
  • • Under Use of Modifiers, the KC and KE modifiers have been removed from this section. The KC and KE modifiers have been removed and replaced with Medicare in the title of this section. Follow Medicare guidelines for the use of current Medicare modifiers.
  • November 2017

    11-30-2017
    Addition(s)/Revisions

    Immunizations & Vaccinations – We added a new influenza vaccine code 90682 and new zoster (shingles) code 90750.

    Pharmacy Services – This revision clarifies the prohibition against auto-refills and addresses general, non-policy related, clean-up of outdated information. This revision also clarifies that paper pharmacy claims are not accepted and MA members may pay cash for phentermine as it is not included in the MA benefit.

    11-22-2017
    Addition(s)/Revisions

    Provider Basics
    Programs and Services

  • Emergency Medical Assistance – We have updated the Emergency Medical Assistance information on PCA services and drug requests to better explain the processes and forms required.
  • 11-17-2017
    Addition(s)/Revisions

    Mental Health Services

  • Intensive Treatment in Foster Care – Intensive treatment services in foster care is a new MHCP reimbursable service. The manual page is now completed for existing and interested providers.
  • 11-16-2017
    Addition(s)/Revisions

  • Hospital Services – We added the word "hospital" after the subheading local trade area.
  • Individualized Education Program (IEP) Services

  • Covered and Noncovered IEP Health-Related Services – We added a section title for telemedicine. We also added a statement to clarify if the school is evaluating a child for the sole purpose of identifying the health-related needs of that child for the child's IEP or IFSP, MA will cover the time spent performing that evaluation or assessment even if the service does not get added to the IEP or IFSP or result in an IEP or IFSP.
  • 11-15-2017
    Addition(s)/Revisions

    Individualized Education Program (IEP) Services

  • Nursing Services – We made only minor spacing and punctuation corrections.
  • Occupational Therapy Services (OT) Services – We made only minor spacing and punctuation corrections.
  • Physical Therapy Services – We made only minor spacing and punctuation corrections.
  • 11-14-2017
    Addition(s)/Revisions

    Early Intensive Developmental and Behavioral Intervention (EIDBI)

  • Early Intensive Developmental and Behavioral Intervention (EIDBI) Provider Enrollment – Updated the Telemedicine section to align with recent legislative changes. Added note to Timelines section to indicate the required site visit. Added language to Agency section regarding the application fee.
  • 11-09-2017
    Addition(s)/Revisions

    Provider Basics
    Provider Requirements

  • Provider Requirements - Rule 101 – We made changes to the application of Rule 101 caseload limits for dental providers. Effective July 1, 2017, dental practices located outside of the seven-county metro area who want to be paid for other state-sponsored health care programs are not subject to the required 10 percent annual active caseload.
  • Provider Basics
    Provider Requirements

  • Provider Screening Requirements – We updated language to indicate MHCP continues required revalidation, and clarified provider revalidation process and timeline. We removed:
  • • exceptions section that is no longer applicable
  • • outdated revalidation schedule
  • outdated revalidation fee, left current revalidation fee amount
  • 11-06-2017
    Addition(s)/Revisions

    Provider Basics
    Provider Requirements

  • Risk Levels and Enrollment Verification Requirements – We updated the risk level for the Intensive Residential Treatment Services (IRTS) provider type from moderate to limited.
  • October 2017

    10-30-2017
    Addition(s)/Revisions

    Mental Health Services – The Mental Health page has been updated to correct the LOCUS link. The link that previously directed a provider to DHS form 6249 now links to the LOCUS provider manual page.

    10-24-2017
    Addition(s)/Revisions

    Individualized Education Program (IEP) Services

  • Covered and Noncovered IEP Health-Related Services – Added a new subsection to clarify coverage for evaluations, reevaluations and assessments needed to determine eligibility for covered services. This incorporates the change in wording from the 2017 legislation with an effective date of Aug. 1, 2017. Added information under Telemedicine about requirement to use place of service 02 for services provided at a distant site via telemedicine.
  • 10-23-2017
    Addition(s)/Revisions

    Certified Community Behavioral Health Clinic (CCBHC) Federal Demonstration Project – The CCBHC Provider Manual has been updated and revised for improved readability and clarity. A Functional Assessment and Level of Care Determination section has also been added to provide billing guidance for this expanded CCBHC service.

    Equipment and Supplies

  • Incontinence Products – In the Authorization subsection, we removed the list of specific incontinence products for recipients under age 4 and stated "incontinence products" instead.
  • Mental Health Services

  • Psychotherapy – We updated psychotherapy sessions allowed prior to completion of a diagnostic assessment under Eligible Providers. Per new legislation, three sessions of a combination of individual or family psychotherapy or psychoeducation are allowed prior to completion of a diagnostic assessment.
  • 10-20-2017
    Addition(s)/Revisions

    Early Intensive Developmental and Behavioral Intervention (EIDBI) Benefit – Updated Service Authorizations section to include the services that require authorization but will allow for 6 month back dating to occur and QSP responsibilities to include coordination of all prior authorizations the recipient has.

    10-19-2017
    Addition(s)/Revisions

    Alcohol and Drug Abuse Services

  • Telemedicine – the telehealth section of the MHCP manual has been added as a sub-section of the Alcohol and Drug Abuse MHCP manual section. This section was in added as starting 10/1/2017, SUD treatment providers may use telemedicine in the delivery of individual, non-residential SUD treatment for MHCP eligible recipients.
  • Hospital Services

  • Inpatient Hospital Services – In the section Inpatient Stays that Exceed 180 Days, we clarified that this applies for the admission dates between November 1, 2014, and June 30, 2017. The differential billing requirement ends for admissions on or after July 1, 2017.
  • Provider Basics
    Billing Policy (Overview)

  • Payment Methodology – Hospital – Added the following information to the Outpatient Hospital Legislative Ratable Add-On subsection:
  • • 3 percent for outpatient hospital services effective September 1, 2014
  • • 90 percent provided by an essential community provider that was formerly a state hospital effective July 1, 2015
  • 10-17-2017
    Addition(s)/Revisions

    Child and Teen Checkups (C&TC) – We revised the C&TC section to reflect the revised Minnesota Child and Teen Checkups (C&TC) Schedule or Age-Related Screening Standards (DHS-3379) (PDF), which is effective October 1, 2017. Content has been updated throughout this section.

    10-16-2017
    Addition(s)/Revisions

    Dental Services

  • Critical Access Dental Payment Program (CADPP) – Added that providers need to submit their patient encounters to DHS annually using form DHS-7602. Also, changed the fax number to submit forms DHS-2669 and DHS-2669A.
  • Hospital Services

  • Inpatient Hospital Services – We deleted the subsection FFS and MCO Transition During Inpatient Hospital Stay under Billing. Fee for service pays for the hospitalization when the patient is admitted under FFS and this does not affect payment if the member moves to an MCO during the hospitalization so this information is not needed.
  • September 2017

    09-28-2017
    Addition(s)/Revisions

    Mental Health Services

  • Assertive Community Treatment (ACT) – The Assertive Community Treatment Provider Manual Page has been updated:
  • • To reflect recent legislative changes
  • • To remove references of ARMHS services
  • • To remove co-occuring services on billing table
  • Physician and Professional Services – Added new place of service requirements for telemedicine. Also added shelter or temporary lodging to list of originating sites.

    Transportation Services

  • Nonemergency Medical Transportation (NEMT) Services (Overview) – Clarified who is responsible for the prior authorization when transport is greater than 30 miles for primary care and 60 miles for specialty care under Authorization Requirements.
  • 09-25-2017
    Addition(s)/Revisions

    Community Emergency Medical Technician (CEMT) Services – Under Covered Services, Post Discharge visits now show that both hospital and nursing home discharges receive the same services.

    Laboratory/Pathology, Radiology & Diagnostic Services

  • Radiology/Diagnostic Services – Added RadSite to the list of accrediting organizations for radiology and diagnostic services in the Eligible Providers subsection.
  • 09-22-2017
    Addition(s)/Revisions

    Equipment and Supplies

  • • In Billing and Documentation, under Detailed Written Orders, we added that an order must contain handwritten or electronic signature and linked to Minnesota Rules about electronic signatures.
  • • In the Face-to-Face rule section:
  • • We removed the requirement of clinical nurse specialists and nurse practitioners working in collaboration with a physician because this is no longer required
  • • We updated the link for DME subject to the face-to-face rule
  • • We added non-physician practitioner to documentation for the medical supplier's records and physician or non-physician practitioner to documentation of a phone call.
  • Equipment and Supplies

  • Airway Clearance Devices – Added in Covered Services that MHCP covers a detachable battery and car charger for a cough stimulating device.
  • 09-20-2017
    Addition(s)/Revisions

    Behavioral Health Home Services – BHH policy has changed and providers are no longer required to have face-to-face contact with clients every 60 days. Providers must have personal contact with client at least once per month to bill for BHH services.

    Provider Basics
    Billing Policy

  • Payment Methodology – Hospital – Updated this page to reflect current payment methodology for hospitals. Also took action on the following subsections:
  • • Clarified the paragraph explaining about critical access hospitals.
  • • Clarified the Outpatient Hospital Facility section.
  • • Replaced the Policy Adjuster Values table for Nov. 1, 2014, to current date with a hyperlink to table in eDocs: Policy Adjuster Values Table (DHS-7619) (PDF).
  • 09-18-2017
    Addition(s)/Revisions

    Provider Basics
    Provider Requirements

  • Access Services – Added definition of telemedicine and interactive audio and video telecommunications, and updated GT and U4 definitions to meet AUC criteria.
  • 09-12-2017
    Addition(s)/Revisions

    Mental Health Services – A Units of Measurement section has been added to clarify the use of HCPCS and CPT codes when billing for mental health services.

    09-08-2017
    Addition(s)/Revisions

    MHCP Member Evidence of Coverage – Updated language and terms for nonemergency medical transportation.

    Provider Basics
    Provider Requirements

  • Access Services – Updated modifiers and definitions for interpretive services. Use the GT modifier with interactive audio and video telecommunications systems interpreter services instead of telemedicine interpreter services. Use the U4 modifier with telemedicine interpreter services.
  • 09-07-2017
    Addition(s)/Revisions

    Provider Basics
    Billing Policy

  • Payment Methodology - Non-Hospital – Updated "Transportation Services" section for transportation service reference to "non-emergency medical transportation" (NEMT), local agency and state administered NEMT, and the end date for proration of NEMT.
  • August 2017

    08-29-2017
    Addition(s)/Revisions

    Anesthesia Services – Clarified where to place the AA modifier on a claim for correct payment under Billing.

    08-28-2017
    Addition(s)/Revisions

    Transportation Services

  • Access Services Ancillary to Transportation – Updated "Covered Services" information to include a link to the "MA Organ Transplant Donor" transplant information in the "Transportation Services Overview" section of the manual.
  • Nonemergency Medical Transportation (NEMT) Services (Overview) – Added information to the "Covered Services" information related to transport and ancillary services for the MA organ transplant donor. Includes information that these services are not available to the EMA recipients.
  • 08-23-2017
    Addition(s)/Revisions

    Provider Basics

  • Billing Policy Overview – Removed reference to ICD-9 since this is no longer valid.
  • Renal Dialysis OverviewChanged the layout of the Renal Dialysis Overview page to be the main page for renal dialysis. These changes will not have any impact on billing for renal dialysis.

    The following changes were made to this page:

  • • Under subheading, "ESRD" we deleted the hyperlink to Method I and Method II, and updated the language for ESRD billing
  • • In the Subheading "Billing", we added a hyperlink to the Renal Dialysis Billing page
  • • We moved subheading and content of " Outpatient ESRD-Related Services" into the hyperlink "Renal Dialysis Billing"
  • • We moved subheading and content of "Inpatient Billing/Non-CAP Payment” into the hyperlink "Renal Dialysis Billing"
  • • Added definition for " Composite Rate"
  • • Deleted definition for Method I - Composite Rate
  • Deleted definition for Method II
  • Renal Dialysis Billing – We changed the layout of this page to reflect current billing acronyms and text used for renal dialysis billing. These changes and updates will not have an impact on how renal dialysis is currently billed.

    The following changes have been made to this page:

  • • The page is now titled Renal Dialysis Billing.
  • • In the Renal Dialysis Overview section, we changed "Method I" to composite rate.
  • • Section links were added to the top of the page for quick access to specific billing information.
  • Renal Dialysis Method II – This section has been removed from the manual and the information has been moved to the Renal Dialysis Overview and Renal Dialysis Billing sections.

    08-10-2017
    Addition(s)/Revisions

    Transportation Services

  • State-Administered NEMT – Replaced outdated terminology, "special transportation," with current terminology, state-administered transportation. Also, changed the procedure codes under the billing example to mode 5 instead of mode 4 to lessen confusion.
  • 08-09-2017
    Addition(s)/Revisions

    Early Intensive Developmental and Behavioral Intervention (EIDBI)

  • Early Intensive Developmental and Behavioral Intervention (EIDBI) Benefit Chart – Updated Billing Grid. Removed the limit of 130 hours in 6 months from EIDBI Observation and Direction codes 0362T and 0363T. Increased the provider limit from 4 to 6 providers a day for EIDBI Intervention. Adjusted the limit on EIDBI Intervention codes 0364T/ 0365T and 0368T/ 0369T to "an average of 40 hours per week" rather than "a maximum of 40 hours per week," to allow medically necessary variance. Updated ITP progress monitoring units to indicate maximum in a 6 month period vs. per year to be consistent with other services.
  • 08-08-2017
    Addition(s)/Revisions

    Provider Basics
    Programs and Services

  • Emergency Medical Assistance (EMA) – Added a link to the End Stage Renal Disease section from the top of this section.
  • 08-01-2017
    Addition(s)/Revisions

    Dental Services

  • Children and Pregnant Women – This update clarifies some inconsistencies between the prior authorization chart bullet points and the dental children and pregnant women page.
  • Provider Basics
    Provider Requirements

  • Provider Participation Requirements – Rule 101 – Edited the caseload limits portion of the Rule 101 page to make it more clear.
  • July 2017

    07-26-2017
    Addition(s)/Revisions

    Hospital Services

  • Inpatient Hospital Authorization – Revised and clarified the language in the subsection, "Concurrent, Continued Stay & Retrospective Reviews" so that it follows legislative changes from Minnesota Statutes 2016, section 256b.0625, subdivision 1. Also added the updated Minnesota Statues 2016, section 256b.0625 to the Legal References section.
  • Inpatient Hospital Services – Updates to medical necessity definition and removal of Pay for Performance Program section as that program no longer exists.
  • Provider Basics
    Programs and Services
    Emergency Medical Assistance (EMA)

  • End Stage Renal Disease (ESRD)Emergency Medical Assistance guidelines have been developed to improve transparency for providers regarding covered and noncovered medications for members eligible under EMA who have End Stage Renal Disease and are undergoing dialysis.
  • 07-24-2017
    Addition(s)/Revisions

    Dental Services

  • Critical Access Dental Payment Program (CADPP) – For MinnesotaCare services provided on or after July 1, 2017, the reimbursement will change from 32.5 percent above the MHCP maximum allowable rate to 20 percent above the allowable MHCP allowable rate.
  • 07-20-2017
    Addition(s)/Revisions

    Provider Basics
    Provider Requirements

  • Excluded Provider Lists – This new section of the manual was previously posted as a webpage. It includes the requirements for checking both the federal and Minnesota excluded providers lists, reporting, and MHCP recovery of funds paid to excluded providers.
  • Transportation Services

    07-17-2017
    Addition(s)/Revisions

    Child Welfare Targeted Case Management (CW-TCM) – Bullet number 11 under Noncovered Services section has been clarified to include the discharge planning provision found in the covered services section, and now reads as follows:

    CW-TCM services for children in an Institution for Mental Disease (IMD) (usually for CD treatment) or a state-operated corrections facility or the secure unit of any residential facility unless it is for discharge planning as stated under the Covered Services section.

    07-14-2017
    Addition(s)/Revisions

    Equipment and SuppliesLanguage requiring a physician co-sign face-to-face documentation has been removed due to the Medicare Access and SHIP Reauthorization Act of 2015 that removed this requirement.

    Individualized Education Program (IEP) Services

  • MHCP Eligible Children – Removed MinnesotaCare program LL as one of the MHCP programs that cover IEP services under Eligible Children.
  • 07-13-2017
    Addition(s)/Revisions

    Individualized Education Program (IEP) Services

  • Covered and Noncovered IEP Health-Related Services – Removed program LL Minnesota Care added NM Chip funded eligibility types PC and CB under Noncovered Services.
  • Mental Health Services – Moved text and added further clarification for CTSS service plan development under CTSS information.
  • Pharmacy Services

  • Point of Sale Diabetic Testing Supply Program – Updated preferred blood glucose monitors and preferred blood glucose testing strips product and NDC tables.
  • 07-10-2017
    Addition(s)/Revisions

    Alcohol and Drug Abuse Services – Corrected percentage of FPG from 100 to 133% in the Financial Eligibility section, bullet 2, of CCDTF eligibility.

    07-07-2017
    Addition(s)/Revisions

    Elderly Waiver (EW) and Alternative Care (AC) Program – Updated Residential Care Services section with information regarding the discontinuation of the service.

    Equipment and SuppliesEffective July 1, 2017, a physician, physician assistant, nurse practitioner, or a clinical nurse specialist (excluding certified mid-wives, audiologists, and podiatrists) is required to maintain documentation of face-to-face encounters for certain medical equipment, appliances and supplies within six months before the start of service (initial dispensing date). A link to the list of DME items subject to the face-to-face rule is included in the revision.

    07-05-2017
    Addition(s)/Revisions

    Equipment and Supplies

  • Transfer and Mobility Device (TRAM) – New policy added for the TRAM transfer and mobility device. This device has a gait training function, sit-to-stand function, and seated transfer function.
  • 07-03-2017
    Addition(s)/Revisions

    Certified Community Behavioral Health Clinic (CCBHC) Federal Demonstration Project – The Certified Community Behavioral Health Clinic (CCBHC) Federal Demonstration Project page has been added to the MHCP Provider Manual. Minnesota certified six participating clinics as meeting the federal certification criteria for the demonstration program effective July 1, 2017, through June 30, 2019.

    June 2017

    06-28-2017
    Addition(s)/Revisions

    Provider Basics
    Programs and Services

  • MHCP Benefits at-a-glance – Removed coverage indicator under MinnesotaCare program LL for Individualized Education Program (IEP) services to align with Basic Health Plan coverage.
  • 06-20-2017
    Addition(s)/Revisions

    Equipment and Supplies

  • Diabetic Equipment & Supplies – Two codes have been added to the HCPCS codes set for continuous blood glucose monitoring effective July 1, 2017:
  • 1. K0553 Supply allowance for therapeutic continuous glucose monitor (CGM) includes all supplies and accessories, 1 unit of service = 1 month's supply
  • 2. K0554 Receiver (Monitor), dedicated for use with therapeutic continuous glucose monitor system
  • Mobility Devices – Under Power Wheelchairs subsection, changed language to conform with policy to state that providers may not bill the codes listed within 30 days of initial issue of a power wheelchair.
  • Transportation Services

  • Nonemergency Medical Transportation (NEMT) Services (Overview) – Made update to proration policy and removal of Medica withdrawal from MCO responsibilities.
  • 06-19-2017
    Addition(s)/Revisions

    Transportation Services

  • Local County or Tribal Agency Nonemergency Medical Transportation (NEMT) Services – Updated and clarified information related to the participation of Medica as a MCO for MHCP from 1-1-17 thru 4-30-17, and the ending of proration of multiple rider transports with dates of service on and after 7-1-2017 under Covered Services.
  • State-Administered Transportation Procedure Codes, Modifiers and Payment Rates – Multiple rider information updated to reflect ending of proration with dates of service on or after July 1, 2017.
  • 06-14-2017
    Addition(s)/Revisions

    Early Intensive Developmental and Behavioral Intervention (EIDBI) BenefitCorrected the information under the Authorization section on the order of the QSP and legal representative's signature on the ITP. Added a link to "Request for Additional Authorization of Services" form under Authorization section. Added additional links under Additional Resources section.

    06-13-2017
    Addition(s)/Revisions

    Provider Basics
    Programs and Services

  • MHCP Benefits at-a-glance – Updated table including: added a separate column for Program IM; added Program XX to column for Program BB; added the services acupuncture, CEMT, community paramedic services and EIDBI; and made updates to covered services for several programs.
  • 06-06-2017
    Addition(s)/Revisions

    Individualized Education Program (IEP) Services

  • MHCP Eligible Children – Added information under Eligible Children to include CHIP-funded major program codes NM-CB and NM-PC.
  • IEP Billing and Authorization Requirements – Clarified the per diem rate, and how schools should add the time for service when an evaluation and service is provided on the same day. Removed text about using the diagnosis code 315.9 prior to Sept. 30, 2015.
  • 06-05-2017
    Addition(s)/Revisions

    Individualized Education Program (IEP) Services

  • Personal Care Assistance (PCA) Services – Added clarifying information for Time Study requirement.
  • 05-26-2017
    Addition(s)/Revisions

    Dental Services (Overview)

  • Non-Pregnant Adults – Prior authorization is not required for scaling and root planning procedures for the limited benefit set; however, they can only be performed in outpatient hospitals and ASC (not in the office).
  • 05-25-2017
    Addition(s)/Revisions

    Dental Services (Overview)Text field entry to bill teledentistry no longer needed and only POS 02 is required to identify services are delivered via teledentistry.

    May 2017

    05-24-2017
    Addition(s)/Revisions

    Laboratory/Pathology, Radiology & Diagnostic Services

  • Laboratory and Pathology Services – Updated the Lab section for drug testing to show what MHCP allows and covers as far as urine drug testing that is medically necessary.
  • Provider Basics
    Provider Requirements

  • Access Services – Clarification of interpreter service modifier use and service coverage as follows:
  • • Clarified for interpreter unit authorization that wait time includes any time a medical service is not being delivered.
  • • Clarified the description for the billing code under Billing Language Interpreter Services for modifier U4
  • 05-23-2017
    Addition(s)/Revisions

    Equipment and SuppliesAdded Nebulizers to the Table of Contents. The language for dispensing orders and detailed written orders has been revised to accommodate electronic medical records. Also, continuous use language for rentals has been added under Covered Services.

    Individualized Education Program (IEP) Services

  • Mental Health Services Added Service Plan Development so that option 2 or 3 CTSS may include time for administering and reporting standardized and measurements of evaluation.
  • 05-22-2017
    Addition(s)/Revisions

    Equipment and Supplies

  • Nebulizers – Policy for nebulizers added to the MHCP Provider Manual.
  • Programs and Services

  • Program HH Dental Authorization Requirement Chart – Removed implant criteria, Program HH does not cover implants. Added many more codes for crowns and pontics (fixed partial dentures). Program HH will now cover more than just stainless steel crowns. Updated prior authorization criteria for crowns and pontics. Removed the age limit for crowns and pontics. Removed the criteria that the client had to have a reason they could not function with a removable denture.
  • 05-18-2017
    Addition(s)/Revisions

    Hospital Services

  • Inpatient Hospital Services – We updated the inpatient hospital payment methodology for prospective payment system (PPS) hospitals. We modified the PPS rates for claims with lengths of stay over 180 days and added instructions in the billing section for inpatient stays that exceed 180 days.
  • 05-17-2017
    Addition(s)/Revisions

    Mental Health Services

  • Adult Day Treatment – The ITP requirement changed from 30 days to 90 days.
  • MHCP Member Evidence of Coverage – We updated the family deductible amount to reflect the 2017 amount. We added nonemergency medical transportation (NEMT) for covered services to the list of covered services under "Emergency medical services and post-stabilization care" and under "Family planning services." We also added gender reassignment surgery to the list of covered services under "Surgery." Under "Transportation to or from medical services," we revised the third bullet under the covered services section to note that coverage of special transportation requires a level-of-service assessment by the state review agent.

    05-10-2017
    Addition(s)/Revisions

    HCBS Waiver Services

  • Home and Community Based Services (HCBS) Programs Provider Enrollment – Updated the name of the link to 6638 from Waiver and AC Programs Service Request Form to HCBS Service Request Form. Added information under processing timelines about approval, pended and denied enrollment applications.
  • 05-03-2017
    Addition(s)/Revisions

    Provider Basics

  • Health Care Programs and Services Overview – Clarified major programs and descriptions for most programs listed in the chart. Added major program XX – state-funded MinnesotaCare for certain noncitizens 21 or older.
  • Tribal and Federal Indian Health Services – We made extensive edits throughout this section. Highlights of changes include the following; however, these are not all of the changes:

  • • Under Eligible Providers we clarified exceptions for tribal and IHS providers meeting the same service and licensure requirements as all other MHCP-enrolled providers
  • • Under Billing:
  • • We clarified information about the provider number
  • • We added information about when to bill MHCP or the managed care organization
  • • We added telemedicine to the list of service categories eligible for reimbursement at the Indian Health Services outpatient reimbursement rate
  • • We removed the outpatient encounter rate information for transportation services
  • We need to make additional edits and will continue to update this section of the manual; please watch for further announcements of changes.

    05-02-2017
    Addition(s)/Revisions

    Provider Basics
    Billing Policy

  • Minnesota-defined U Modifiers – Added to the following:
  • U5: GRH supplemental services H0043 and H0044
  • U6 for MHM: S5111 replaced T2013, S5116, T2038. Also added mod UA for S5135 and UB for S5150.
  • U7: ADC, FADS S5100 for all waivers, ECS, and AC and ADC, FADS S5102 for all waivers and AC
  • U9: 24 hour CLS foster care under age 65 T2031 TG
  • UC: Transportation (waiver, one-way trip) T2003 and (mileage) S0215
  • UD: Assistive technology assessment
  • Removed from U9: Behavioral program by aide
  • 05-01-2017
    Addition(s)/Revisions

    Reproductive Health/OB-GYN

  • Minnesota Family Planning Program (MFPP) Procedure Codes – Added birth control codes J7307, J7297 and J7298. Codes J7297 and J7298 replace J7302.
  • April 2017

    04-26-2017
    Addition(s)/Revisions

    Hospital Services

  • Critical Access Hospital (CAH) Services – We revised this section throughout to reflect the new payment methodology for critical access hospitals. Changes include the following:
  • • Under Outpatient Payments we added the formula and process of how the payment rate through fiscal years ending in 2016 and in 2017 are determined.
  • • Under Inpatient Payment we clarified that payment for inpatient hospital services has moved to a tiered per diem payment effective for discharges on or after July 1, 2015, and added a section about New Cost-Based Inpatient Payment Methodology. We also clarified the date of admission for admissions prior to October 1, 2015, and discharges on or after October 1, 2015.
  • Mental Health Services

  • • The following information has been updated under Admission Criteria:
  • • An FA must also be completed prior to receiving services and no sooner than 30 days prior. An FA is valid for 180 days
  • • A LOCUS must also be completed prior to receiving services and no sooner than 30 days prior.
  • • The following information has been added to Covered Day Treatment Services:
  • • Be completed before the completion of five working days in which service is provided or within 30 days after the diagnostic assessment is completed or obtained, whichever occurs first.
  • • The ITP and subsequent revisions of the ITP must be signed by the client before treatment begins. The mental health professional or practitioner shall request the client, or other person authorized by statute to consent to mental health services for the client, to sign the client's ITP or revision of the ITP.
  • • If the client or authorized person refuses to sign the plan or a revision of the plan, the mental health professional or mental health practitioner shall note on the plan the refusal to sign the plan and the reason or reasons for the refusal.
  • Mental Health Services

  • • CTSS Authorization Codes – This page has been deleted because it was duplicative of information found in the Billing section of the CTSS section in the Provider Manual.
  • 04-25-2017
    Addition(s)/Revisions

    Mental Health Services

  • Children’s Mental Health Clinical Care Consultation – Updated Eligible Providers section to include osteopathic physician.
  • 04-21-2017
    Addition(s)/Revisions

    Hospital Services

  • Outpatient Hospital Services – Added in Billing that E&M services are priced using a composite rate when there are eight or more hours of observation.
  • 04-20-2017
    Addition(s)/Revisions

    Elderly Waiver (EW) and Alternative Care (AC) Program – Added clarifying language regarding billing for transportation and adult companion or ICLS on the same day. Also added language to residential care services about discontinuation of the service.

    HCBS Waiver Services

  • Training Requirements – Added link to Waiver and AC Provider 101 training and waiver billing lab. Added: print proof of completion to submit with your application request, and removed "or" between homemaker and cleaning.
  • Reproductive Health/OB-GYN

  • Minnesota Family Planning Program (MFPP) Procedure Codes – Codes 87806 for Alere HIV testing and 11983 for contraception were added to the MFPP Procedure Codes list.
  • 04-17-2017
    Addition(s)/Revisions

    Provider Basics
    Programs and Services

  • Program HH (HIV/AIDS) Covered Services – Program HH now covers fixed partials (crowns and pontics).
  • Provider Basics
    Provider Requirements

  • • Clarified under Covered expenses the local agency requirements to inform members about transportation and ancillary services.
  • Clarified interpreter information that transportation providers reimbursement does not include interpreter service reimbursements, and to submit an authorization request for additional interpreter service units only after the allowed 8 units have been used.
  • Transportation Services

  • Local County or Tribal Agency Nonemergency Medical Transportation (NEMT) ServicesInformation added to better identify transport mileage reimbursements for personal mileage and volunteer drivers. Beginning April 1, 2017, MNET will coordinate Local County or Tribal Agency Nonemergency Medical Transportation (NEMT) Services for Mille Lacs County.
  • 04-14-2017
    Addition(s)/Revisions

    Equipment and Supplies – Weighted Vests have been added to the Weighted Blankets section.

  • Positioning Equipment – Positioning systems have been added to the third bullet point under Positioning Cushions, Pillows and Wedges section of the policy.
  • 04-07-2017
    Addition(s)/Revisions

    Elderly Waiver (EW) and Alternative Care (AC) Program – Added Individual Community Living Support (ICLS) services and added a link to the Community Based Services Manual (CBSM) under Covered Services.

    March 2017

    03-28-2017
    Addition(s)/Revisions

    Anesthesia Services – Removed 2015 anesthesia rate information and added the 2017 anesthesia rates.

    Intermediate Care Facilities (ICF/DDs) – Changed link for MN–ITS user manual from HCBS Waiver, Alternative Care (AC), Moving Home Minnesota and Group Residential (GRH) Supplemental Services claims to DT&H and ICF-DD Special Needs claims under Billing.

    03-23-2017
    Addition(s)/Revisions

    Alcohol and Drug Abuse Services – Updated DAANES communication to advise providers of new MHCP DAANES contact. Removed outdated MinnesotaCare information from Managed Care section. Updated rate reform grid effective date from 3/1/2013 to 9/9/2016. Updated Revenue and Procedure Code table to include High Intensity Committed/Complex codes.

    03-17-2017
    Addition(s)/Revisions

    Provider Basics

  • Managed Care Organizations (MCOs) and Prepaid Health Plans (PPHPs) – Added RSC-TCM carved out service for SNBC enrollees and made text clarifications throughout the section.
  • 03-16-2017
    Addition(s)/Revisions

    Child and Teen Checkups (C&TC) –Clarified information for nonenrolled public health nurses in the Eligible Providers section.

    Laboratory/Pathology, Radiology & Diagnostic Services

  • Laboratory and Pathology Services – Clarified genetic testing for breast cancer. MHCP allows payment for one of the following tests:
  • • Oncotype Dx – bill this test using HCPC S3854 or
  • • EndoPredict – bill this test using HCPC S3854 beginning Jan. 1, 2017.
  • 03-15-2017
    Addition(s)/Revisions

    Individualized Education Program (IEP) Services

  • Interpreter Services – Clarified under Overview when Medical Assistance will reimburse for interpreter services and under Sign Language Interpreter Services that inclusion on the Minnesota Department of Health roster is not evidence that the person is certified as an interpreter.
  • 03-13-2017
    Addition(s)/Revisions

    Early Intensive Developmental and Behavioral Intervention (EIDBI) BenefitUpdated EIDBI policy manual links and edited Service Agreement and Billing content. Added links to 60 day temporary increase form and Technical Change form.

    03-10-2017
    Addition(s)/Revisions

    Child and Teen Checkups (C&TC) – In the Maternal Depression Screening subsection we added language regarding a NCCI bundling edit when using code 96161. In the Vision Screening subsection we revised language regarding an NCCI bundling edit when using code 99173.

    03-08-2017
    Addition(s)/Revisions

    Dental Services (Overview)Added a section "Locum Tenens Dentist" with information about allowing a dentist to retain a substitute dentist for reasons such as illness, vacation, education and medical leave.

    Equipment and SuppliesUpdated miscellaneous product section to include information for weighted blankets.

    03-07-2017
    Addition(s)/Revisions

    Equipment and Supplies

  • Nutritional Products and Related Supplies – Minor revisions due to 2017 HCPCS changes. Changed code for feeding pumps from B9000 to B9002. Added information for repairs to pumps originally dispensed at B9000 in the Billing subsection.
  • 03-03-2017
    Addition(s)/Revisions

    Mental Health Services

  • Adult Rehabilitative Mental Health Services (ARMHS) – Error on billing table. Changing H0031 UD TS from mental health assessment, by physician, follow-up service (review or update) to mental health assessment, by non-physician, follow-up service (review or update).
  • Dialectical Behavior Therapy Intensive Outpatient Program (DBT IOP) – The recommended duration for DBT –IOP skills group training has been changed to a minimum of two hours weekly with an option to last up to two and a half hours. Updated team member requirements and discharge criteria.
  • 03-02-2017
    Addition(s)/Revisions

    Behavioral Health Home Services – The BHH services section of the MHCP Provider Manual has been updated with the following:

  • • Clarify that there is not a particular order in which providers must assess eligibility for BHH services; simply that they must ensure that all criteria have been met
  • • Clarify that provider type is required if BHH services provider is billing using a billing entity
  • • Clarify that BHH providers must submit claims that correspond with the BHH services certification approval letter
  • Early Intensive Developmental and Behavioral Intervention (EIDBI)

  • Early Intensive Developmental and Behavioral Intervention (EIDBI) Benefit Grid – Updated provider limits and service limits on the EIDBI billing grid.
  • February 2017

    02-24-2017
    Addition(s)/Revisions

    Equipment and Supplies

  • • Clarified billing policy for dually eligible recipients in long-term care facilities.
  • • Added that MHCP does not cover the following:
  • • Stands, racks, and wheeled carts for oxygen equipment
  • • Replacement accessories for portable concentrators
  • Provider Basics
    Billing Policy

  • Payment Methodology – Hospital – General clarifications throughout the section, including the following:
  • • Revised and updated this section to reflect the Legislation that passed in 2013 directing DHS to develop new payment methodologies for fee-for-services (FFS) inpatient hospital services provided by diagnosis related group (DRG) hospitals, critical access hospitals, and rehabilitation hospitals
  • • Deleted outdated information about programs or services that have ended
  • • Updated the Critical Access Hospital subsection to reflect the new MHCP cost-based inpatient payment methodology according to the 2013 legislative directive
  • • Deleted the outdated process of appeal for case mix procedure
  • • Updated the Inpatient Hospital Services subsection to show the new payment methodologies for fee-for-services (FFS) inpatient hospital services provided by diagnosis related group (DRG) hospitals, as directed in the 2013 legislation
  • Updated and clarified some of the definitions
  • 02-22-2017
    Addition(s)/Revisions

    Pharmacy Services

  • 340B Drug Pricing Program – Under 340B-covered entities, changed "children's hospitals" to "free-standing cancer hospitals." Deleted the Managed Care Organizations (MCOs) subsection and clarified information for 340B Contract Pharmacies.
  • 02-21-2017
    Addition(s)/Revisions

    Child and Teen Checkups (C&TC) – In the Maternal Depression Screening subsection we added that a modifier is needed when using code 96161.

    Eyeglass and Vision Care Services – Added contact information for new vendor, Classic Optical Laboratories, Inc. Clarified coverage criteria for specialty eyeglass lenses and changed quantity limits for contract to comply with federal Correct Coding Initiative (CCI) editing requirements.

    02-15-2017
    Addition(s)/Revisions

    Equipment and Supplies

  • • Removed obsolete information about providers who may provide diabetic equipment and supplies.
  • • Under Blood Glucose Monitors:
  • • Code E0607 is no longer an eligible covered code
  • • Deleted statement that authorization is required only for excess quantities. Authorization is always required for specialty blood glucose monitors E2100 and E2101.
  • • Deleted Authorization information from the Blood Glucose Test Strips subsection
  • Mental Health Services

  • Adult Rehabilitative Mental Health Services (ARMHS) – Corrected 02/06/2017 changes to ARMHS billing table.
  • 02-10-2017
    Addition(s)/Revisions

    Pharmacy Services

    Mental Health Services

  • Adult Rehabilitative Mental Health Services (ARMHS)The billing table has been changed to add updates to ARMHS coding for transition to community living. Modifier UD has been updated to U3 and now reads as follows:
  • H2017 U3 - Basic living and social skills, transitioning to community living (TCL)
  • H2017 U3 HM - Basic skills, transitioning to community living (TCL) by a mental health rehabilitation worker
  • Provider Basics
    Provider Requirements

  • Access Services – Added process for authorization of interpreter units after the allowed 8 units for a single date of service.
  • 02-06-2017
    Addition(s)/Revisions

    Individualized Education Program (IEP) Services

  • IEP Providers – IEP provider contact list updated with new DHS email address for sending in new or updated contact information.
  • Mental Health Services

  • Adult Rehabilitative Mental Health Services (ARMHS)The billing table has been changed to add updates to ARMHS coding for transition to community living. Modifier UD has been updated to U3 and now reads as follows:
  • H2017 U3 - Basic living and social skills, transitioning to community living (TCL)
  • H2017 U3 HM - Basic skills, transitioning to community living (TCL) by a mental health rehabilitation worker
  • Provider Basics
    Provider Requirements

  • Access Services – Added process for authorization of interpreter units after the allowed 8 units for a single date of service.
  • 02-03-2017
    Addition(s)/Revisions

    Reproductive Health/OB-GYN

  • Minnesota Family Planning Program (MFPP) Procedure Codes – Clarified which code to use when prescribing hormonal or nonhormonal contraceptives.
  • 02-02-2017
    Addition(s)/Revisions

    Physician and Professional Servicesadded link to Gender-Confirming Surgery in the Table of Contents.

  • Gender-Confirming Surgery – Added a new section about MHCP coverage for gender confirming surgery.
  • January 2017

    01-27-2017
    Addition(s)/Revisions

    Hospital Services

  • Inpatient Hospital Services – Added Emergency Medical Assistance coverage of kidney transplants in the Coverage Limitations subsection.
  • 01-23-2017
    Addition(s)/Revisions

    HCBS Waiver Services – Added night supervision services under Covered Services for CADI.

    01-20-2017
    Addition(s)/Revisions

    Equipment and Supplies

  • Mobility Devices – Minor revisions to reflect changes to HCPCS codes that include the following:
  • • Added E1012 to power leg elevation systems
  • • Added E1014 to manual, fully or semi-reclining backs.
  • Laboratory/Pathology, Radiology & Diagnostic Services

  • • Changed HCPC codes G0477- G0479 to CPT codes 80305-80307 or G0480 – G0483 per encounter for dates of service on and after January 1, 2017.
  • • Clarified that effective November 1, 2016, codes 80300-80304 and 80320 – 80377 are no longer covered
  • • Added that effective January 1, 2017, codes G0477 – G0479 will be deleted
  • Mental Health Services

  • Psychotherapy – Clarified billing for codes 90846-90849 that are used to report family psychotherapy. Family psychotherapy coding may be separately reported for each patient in the family group, however, it should not be reported for each family member.
  • Reproductive Health/OB-GYN

  • Minnesota Family Planning Program (MFPP) – Added covered diagnosis code range to the Covered Services section.
  • 01-19-2017
    Addition(s)/Revisions

    Programs and Services

  • Emergency Medical Assistance (EMA) - Added that EMA covers nonemergency medical transportation only for services covered under EMA under the Covered Services section.
  • 01-17-2017
    Addition(s)/Revisions

    Laboratory/Pathology, Radiology & Diagnostic Services

  • Radiology/Diagnostic Services – Updates under Billing subsection for Medicare outpatient hospital changes effective 2016 and 2017 for computed tomography modifier CT, x-rays taken by film (requiring modifier FX) and stereotactic radiosurgery planning and delivery modifier CP.
  • 01-13-2017
    Addition(s)/Revisions

    Physician and Professional Services

  • • Removed mental health telemedicine information from this section and linked to the Telemedicine Delivery of Mental Health Services section for this information.
  • • Added services to the Coverage Limitations section that are not covered under telemedicine.
  • • Added off-campus provider-based billing changes for modifiers PO and PN.
  • • Added a section for Off-Campus Provider-Based Hospital Department Services
  • Transportation Services

  • Access Services Ancillary to Transportation – Added Emergency Medical Assistance (EMA) and Minnesota Family Planning Program (MFPP) to the Eligible Recipients section.
  • Ambulance Transportation Services – Removed reference to ICD-9 codes.
  • Local County or Tribal Agency Nonemergency Medical Transportation (NEMT) Services – Added Emergency Medical Assistance (EMA) to the Eligible Recipient section. Added to the Noncovered Services section that transport is not covered for EMA recipients for obtaining routine or preventative care or services.
  • Nonemergency Medical Transportation (NEMT) Services (Overview) – Added Emergency Medical Assistance (EMA) to the Eligible Recipient section and added to the Noncovered Services section that transport of an EMA recipient for routine or preventative care is not covered.
  • Protected Transportation Services – Clarification of major program eligibility information for Eligible Recipients.
  • State-Administered NEMT – Added Minnesota Family Planning Program (MFPP) and Emergency Medical Assistance (EMA) to Eligible Recipients.
  • 01-12-2017
    Addition(s)/Revisions

    Hospital Services

    01-11-2017
    Addition(s)/Revisions

    Early Intensive Developmental and Behavioral Intervention (EIDBI)

  • Early Intensive Developmental and Behavioral Intervention (EIDBI) Provider Enrollment – Revised the Assurance Statement titles by removing the reference to DBI and ABA for providers Levels I,II,III.
  • Equipment and Supplies

  • Electrical Stimulation Devices – Minor changes to reflect 2017 HCPCS code description change under Covered Services.
  • Provider Basics
    Billing Policy

  • Billing the Recipient – Added information for the 2017 copays and family deductible.
  • 01-09-2017
    Addition(s)/Revisions

    Equipment and Supplies

  • Patient Lifts and Seat Lift Mechanisms – Coding update for 2017 HCPCS codes.
  • 01-06-2017
    Addition(s)/Revisions

    Mental Health Services

  • Mental Health Certified Family Peer Specialist – The new Mental Health Family Peer Specialist page has been added.
  • 01-05-2017
    Addition(s)/Revisions

    Immunizations & Vaccinations – Changed age restrictions for CPT code 90686 and 90688 from 3 years to 6 months and older.

    Rehabilitation Services

  • Audiology Services Procedure Codes – Updated page title, removed "authorization required" for code 92700 and replaced with "description required".
  • 01-04-2017
    Addition(s)/Revisions

    Mental Health Services

  • Adult Day Treatment – Added an Overview section defining what constitutes a day treatment service and the MN statutes that explain what facilities can provide the service.
  • Adult Rehabilitative Mental Health Services (ARMHS) – Updated adult rehabilitative mental health services (ARMHS) definition to reflect MN Statute 256B.0623, Subd. 2. Updated modifiers for HCPS codes H0031 and H0032 on billing grid. The following changes were applied to the billing table:
  • • H0031 Brief Description changed from Functional Assessment to Mental Health assessment by non-physician and the UD modifier was added.
  • • Modifier UD was added to the TS modifier for H0031 Functional Assessment Update/Review.
  • • The UD modifier was added for procedure H0032 Individual Treatment Plan.
  • • Modifier UD was added to the TS modifier for H0032 Individual Treatment Plan Update/Review.
  • • Per 15 minutes was added to the unit section of the billing table for the services, Functional Assessment, Mental Health Assessment (H0031 UD/H0031 UD TS) and Functional Assessments (H0032 UD/H0032UD TS).
  • Provider Basics
    Provider Requirements

  • Provider Screening Requirements – Updated text from old fee amount to new fee amount.
  • Risk Levels and Enrollment Verification RequirementsChanged provider type 72 from broker to coordinator to more closely fit the definition of enrolled provider type 72.
  • Rehabilitative Services

  • Rehabilitative Services Procedure Codes – Added new 2017 OT/PT evaluation codes and updated some code descriptions.
  • Previous Revisions

    2016 Manual Revisions

    2015 Manual Revisions

    2014 Manual Revisions

    2013 Manual Revisions

    2012 Manual Revisions

    2011 Manual Revisions

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    © 2017 Minnesota Department of Human Services Updated: 12/7/17 2:51 PM | Accessibility | Terms/Policy | Contact DHS | Top of Page | Updated: 12/7/17 2:51 PM