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Minnesota Department of Human Services Provider Manual
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MHCP Provider Manual

Latest Manual Revisions

Revised: April 18, 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.

April 18

  • Nursing Facilities – We made several clarifications in the section.
  • • A new information was added about the case mix file. Under Billing Guidelines, added new paragraph titled Exceptions for Prepaid Health Plans. In Rehabilitative Services, removed following paragraph:
  • Note: The provider that bills for and receives payment for services is responsible for the accuracy of the claims and for maintaining patient records that fully disclose the extent of the benefits provided. Also, if Medicare requires the nursing facility to do the billing for Medicare covered rehabilitative services for dually eligible recipients; you must follow Medicare's requirements until Medicare benefits are exhausted.
  • • Under Billing Guidelines, added link to MN–ITS User Manual for instructions on completing Long Term Care claims.
  • Transportation Services

  • • Clarified that fee for service recipients have to contact their county of residence for policies and procedures regarding NEMT modes 1 - 4.
  • • Moved mode 4 - assisted transport information from state-administered NEMT page to the local county or tribal agency NEMT page
  • • Added Pine County to the list of counties contracted with MNET.
  • • Removed information about MnDOT variances; MnDOT no longer issues variances
  • • Added information about recipients residing in a nursing facility
  • • Added trip documentation requirements
  • • Removed rate information. This information is in the Local County or Tribal Agency Nonemergency Medical Transportation (NEMT) Services Claim, Service, and Rate Information section
  • State-Administered NEMT – Removed references to mode 4 unassisted transportation and moved them to the county tribe transportation page as mode 4 is administered by the counties and tribes not the state.
  • April 4

    Equipment and Supplies

  • Urological and Bowel Supplies – We changed the name of this section to Urological and Bowel Supplies and added coverage information for the anal irrigation system and accessory unit.
  • • We added information under Indwelling Catheters or Insertion Trays about documentation of medical necessity (such as recurrent encrustation, inability to pass a straight catheter, or sensitivity to latex) for a specialty catheter (A4340) or a silicone catheter (A4312, A4315, A4344) that is now required.
  • • We clarified that authorization is always required for code A4459 and accessory units under code A9999 and to use modifier NU when billing these codes.
  • March 28

    Equipment and Supplies

  • • In the Mobility Devices section, under Wheelchairs in Long Term Care Facilities, we deleted the requirement that documentation must demonstrate absence of a progressive condition.
  • March 27

    Provider Basics

  • Authorization – Deleted the "MHCP" section on this page that listed forms specific to program HH and home care. You can find the following forms on the Program HH (HIV/AIDS) Covered Services section of the Provider Manual:
  • • Nutritional Supplemental Authorization Request Form - Program HH (DHS-5849) (PDF)
  • • Greater Minnesota Meal Program Referral Form-Program HH (DHS-6348) (PDF)
  • • Medication Therapy Management Services (MTMS) Authorization Form (DHS-6246) (PDF)
  • You can find the Service Agreement Quick Reference Guide through the link in several places where it is most appropriate within the Provider Manual.

    Transportation Services

  • • Under Personal and Volunteer Driver Mileage clarified that reimbursement is up to 100 percent of the IRS business deduction rate in place on date of service.
  • • Under Rural Urban Community Area (RUCA) clarified that if the claim service line has 51 or more miles on it RUCA would not apply.
  • March 21

    Child and Teen Checkups (C&TC)We made the following revisions and updates in this section:

  • • Identified the six screening components from the Oct. 1, 2017, C&TC Periodicity Schedule that are not required to be implemented until March 1, 2018. These components are:
  • 1. Weight for length percentile, under physical growth and measurement component
  • 2. Social determinants of health, under the health history component
  • 3. Human immunodeficiency virus (HIV) screening lab test
  • 4. Near visual accuity (plus lens) screen ng beginning at age 5, under vision screening component
  • 5. Addition of 6000Hz at 20 dB screening for age 11 and over, under hearing screening component
  • 6. Dyslipidemia risk assessment for children at ages indicated on the Periodicity Schedule
  • • Changed that C&TC program staff provide outreach communications and assistance to families of children younger than age 20, to families of children younger than age 11 requiring further evaluation, diagnosis and treatment for a condition identified during the C&TC screening visit.
  • • Added a new Laboratory Tests or Risk Assessment subsection with billing information details about documenting in the medical record the required lab test results or the reason a required lab test was not done.
  • • Added a Hematocrit or hemoglobin subsection.
  • • Clarified language in the Sexually transmitted infection (STI) risk assessment and human immunodeficiency virus (HIV) screening lab test subsection regarding confidentiality and documentation of this required screening component, including the reason, if the HIV blood test was not done.
  • • Under Screening exceptions, claim guideline exceptions table, we made the following changes in the Exception Reason and Situations:
  • • From "Condition already identified," deleted the exception for an adolescent already diagnosed with HIV from
  • • From "Screening recently provided" :
  • • Deleted lead screening was performed at a different agency
  • • Clarified hearing or vision screening
  • • Deleted HIV screening performed at a different agency
  • • Added information about mental health screening recently performed
  • • From "Parent or young adult," deleted HIV screening offered but youth declined the test
  • • In Two-character HIPAA-Compliant Referral Condition Codes and Definitions we removed "not including dental referrals" from the ST (new diagnosis or treatment service requested) instructions.
  • Hospital Services

  • Hospital In-reach Service Coordination (IRSC) – We deleted the subsection "Past Timely Filing." IRSC claims are to be submitted within the same timelines as any other claim type. For information on timely filing of a claim see Provider Basics, Billing (Overview), Timely Filing section.
  • March 20

    Optical ServicesChanged the name of the eyeglasses and vision services section in the provider manual to Optical Services.

    March 19

    Hospital Services

  • Critical Access Hospital (CAH) Services – We removed the Critical Access Hospital Rates - Fee-for-Service form (DHS-3786) and added a link to the payment methodology for critical access hospitals webpage for rate information.
  • March 16

    Physician and Professional Services

  • • We deleted the Pay-for-Performance Program (p4p) section from the MHCP Provider Manual. This program has not been active since 2011.
  • March 8

    Early Intensive Developmental and Behavioral Intervention (EIDBI)

  • Early Intensive Developmental and Behavioral Intervention (EIDBI) Benefit Grid – We added that EIDBI providers who are billing for telemedicine services are to continue using the GT modifier, as well as selecting POS (place of service) 02 to their claim lines.
  • Medication Therapy Management Services (MTMS)

  • Medication Therapy Management Services (MTMS) – Added the provider must submit the Provider Assurance Statement for Telemedicine before billing MHCP.
  • Mental Health Services

  • Dialectical Behavior Therapy Intensive Outpatient Program (DBT IOP) – We updated the following information:
  • Treatment plan must include measurable goals for stage one DBT treatment and must be updated every 90 days.
  • • A one-time authorization for up to an additional 78 units for prolonged exposure protocol has been added to the billing table.
  • March 7

    Mental Health Services

  • Adult Rehabilitative Mental Health Services (ARMHS) – We added a link to the ARMHS policy page in the Eligible Provider section.
  • March 3

  • Acupuncture Services – Effective January 1, 2018, the 20 allowed acupuncture units will be based on a calendar year, rather than on an annual basis.
  • February 28

    Hearing Aid Services

  • Hearing Aid Services Codes
  • • Updated code descriptions of the following:
  • • V5100, V5110, V5267, V5274, V5011
  • • Renamed the last column to "Notes" to include general additional information about some codes and made these revisions:
  • • Deleted obsolete information
  • • Listed specific items that require authorization
  • • Added the following:
  • • V5274 requires a description; use only when a more appropriate code is not available
  • • Contracted CROS/BiCROS systems include a compatible hearing aid
  • • Authorization and billing information about certain assistive listening devices/FM systems and components
  • • Limits on standard batteries
  • • V5267 must be used for rechargeable batteries
  • • Details for use of repair code V5014
  • February 13

    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.
  • February 12

    Equipment and Supplies

  • Hospital Beds – Changed "safety beds" to "enclosed beds."
  • February 9

    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)
  • February 7

    Provider Basics
    Programs and Services

  • Health Care Programs and Services Overview
  • • 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.
  • February 6

    Anesthesia Services – Added the 2018 anesthesia rates chart.

    February 2

    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.
  • February 1

    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.
  • Hospital Beds
  • • 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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