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MHCP Provider Manual

2011 Manual Revisions

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.

12/23/2011

Addition(s)/Revision(s)

Chiropractic Services – Legislative changes effective 1/1/12 - restoring CMT from 12 to 24 annual units

Hospital Services – Added Evidence-based Childbirth Program Policy information

12/22/2011

Addition(s)/Revision(s)

Elderly Waiver (EW) and Alternative Care (AC) Program – Removed broken links

12/19/2011

Addition(s)/Revision(s)

Rehabilitative Services – Updated manual material to reflect January 1, 2012 legislative change eliminating SMT coverage for recipients 21 and older

12/14/2011

Addition(s)/Revision(s)

Physician and Professional Services – Added two sentences under smoking cessation -- states that smoking cessation products are subject to quantity limits consistent with the FDA-approved dose

12/13/2011

Addition(s)/Revision(s)

HCBS Waiver Services – Removed Nutritional Services section

Provider Basics

  • Billing the Recipient – Added ARRA, end-date GAMC and CCDS copay, and 5% of gross income information
  • 12/08/2011

    Addition(s)/Revision(s)

    Elderly Waiver (EW) and Alternative Care (AC) Program – Removed statement about requiring physician orders in the specialized supplies and equipment section

    11/30/2011

    Addition(s)/Revision(s)

    Inpatient Hospital Authorization – Updated the medical review agent information

    Physician and Professional Services – Clarified physician-administered drugs and text that the MHCP Prescription Drug PA Agent reviews requests for physician-administered drugs

    11/29/2011

    Addition(s)/Revision(s)

    Reproductive Health/OB-GYN

  • Hysterectomy – Clarified PA requirements for hysterectomies
  • 11/22/2011

    Addition(s)/Revision(s)

    Reproductive Health/OB-GYN

  • Minnesota Family Planning Program (MFPP) – J0561 replaces both J0570 and J0580 for the injection of penicillin G benzathine under Secondary MFPP Services
  • 11/16/2011

    Addition(s)/Revision(s)

    Laboratory/Pathology, Radiology & Diagnostic Services

  • Radiology/Diagnostic Services – Clarified exception for the technical component when it is an emergency done in an ambulatory surgical center or in an outpatient setting
  • 11/15/2011

    Addition(s)/Revision(s)

    Equipment & Supplies – New policy about coverage of miscellaneous products, removed obsolete references to modifier 22, added information about 13 month rental period

    11/10/2011

    Addition(s)/Revision(s)

    Reproductive Health/OB-GYN

  • Free-Standing Birth Center Services – Updated billing information with Revenue codes
  • 11/08/2011

    Addition(s)/Revision(s)

    Laboratory/Pathology, Radiology & Diagnostic Services

  • Laboratory/Pathology Services – Clarified specimen handling policy, changed blood collection policy, added genetic modifier requirement, added Oncotype Dx coverage criteria
  • 11/04/2011

    Addition(s)/Revision(s)

    Authorization – Added hearing aids to fax numbers for the medical review agent

    Health Care Homes (HCH) – Fixed link to HCH MN–ITS User Guide, added link to HCH public page and added Practice-specific Provider Alert reports

    11/02/2011

    Addition(s)/Revision(s)

    Authorization – Changed name of medical review agent to Telligen and added more fax numbers

    11/01/2011

    Addition(s)/Revision(s)

    Nursing Facilities – Removed MREP information

    10/27/2011

    Addition(s)/Revision(s)

    Authorization – Added new information about authorization requirements when the recipient has TPL or Medicare

    Equipment & Supplies

  • Specialized Wound Treatment Technology – Added K0743 as covered negative pressure wound therapy device under Covered Services
  • Eyeglass and Vision Care Services – Updated HCPCS code under Hydrophilic contact lens

    10/21/2011

    Addition(s)/Revision(s)

    Provider Basics

  • Programs and Services – Updated information in programs BB, EH and deleted program GM information
  • Renal Dialysis

  • Renal Dialysis - Method 1 – Updated billing information
  • 10/20/2011

    Addition(s)/Revision(s)

    Provider Basics

  • Program HH (HIV/AIDS) Covered Services – Updated Nutrition Benefit information
  • 10/12/2011

    Addition(s)/Revision(s)

    Provider Basics

  • Provider Requirements – Added Licensed Professional Clinical Counselors (LPCCs) under Eligible Providers
  • 10/07/2011

    Addition(s)/Revision(s)

    Equipment & Supplies

  • Diabetic Equipment & Supplies – Removed text indicating authorization is required for code A9276
  • Laboratory/Pathology, Radiology & Diagnostic Services

  • Laboratory Authorization Code List – Updated PA list
  • 10/06/2011

    Addition(s)/Revision(s)

    Physician and Professional Services – Clarified text about billing

    Provider Basics

  • Prepaid Minnesota Health Care Programs (PMHCP) – Added information about the 7/1/11 inpatient hospital carve-out for some MinnesotaCare enrollees
  • 10/04/2011

    Addition(s)/Revision(s)

    Equipment & Supplies – Removed instructions for billing 2 respiratory suction pumps on the same date

    Provider Basics

  • Billing Policy
  • Payment Methodology – Hospital – Added link to spreadsheet listing the fee for service inpatient hospital rates in effect for all hospitals as of 1/1/11
  • 10/03/2011

    Addition(s)/Revision(s)

    Rehabilitative Services

  • Service Thresholds - Occupational Therapy, Physical Therapy, Speech-Language Pathology – Deleted codes G0281 and G0282 for investigative services as identified in BCBS medical policy
  • 09/30/2011

    Addition(s)/Revision(s)

    Provider Basics

  • Provider Requirements
  • Access Services – Clarified interpreter service billing
  • 09/29/2011

    Addition(s)/Revision(s)

    Physician and Professional Services

  • Pay-for-Performance Program – Clinical results for optimal care blood pressure was changed to < 140/90
  • 09/28/2011

    Addition(s)/Revision(s)

    Elderly Waiver (EW) and Alternative Care (AC) Program

    09/27/2011

    Addition(s)/Revision(s)

    Community Health Worker (CHW) – Updated to reflect new policies and procedures

    Dental Services (Overview) – Updated circumstances when dentist may be involved with fabrication of an apnea appliance, authorization and billing information

    Elderly Waiver (EW) and Alternative Care (AC) Program – Updated Chore section

    Mental Health Services

  • Adult Crisis Response Services – Revised authorization criteria section
  • Mental Health Provider Travel Time – Text clarification and added legal reference
  • Psychological Testing – Clarified distinction between clinical trainee and technicians
  • Nursing Facilities – Updated private room section

    Reproductive Health/OB-GYN

  • Minnesota Family Planning Program (MFPP) – Updated contraceptive list
  • 09/26/2011

    Addition(s)/Revision(s)

    Health Care Homes (HCH) – Clarification on effective date under Patient Care Management Tool

    Physician and Professional Services – Removed GAMC reference in the MNT and DSMT sections

    09/23/2011

    Addition(s)/Revision(s)

    Pharmacy Services – Updated all references to AWP and updated reimbursement information for clotting factors

    09/20/2011

    Addition(s)/Revision(s)

    Elderly Waiver (EW) and Alternative Care (AC) Program – Updated Chore section

    Pharmacy Services

  • Drug Categories with Limited Coverage – Removed listing of benzonatate as a covered cough product
  • Provider Basics

  • Program HH (HIV/AIDS) Covered Services – Updated information under Mental Health Benefit
  • 09/15/2011

    Addition(s)/Revision(s)

    Equipment & Supplies

  • Pneumatic Compression Devices – New policy for peripheral artery disease
  • 09/12/2011

    Addition(s)/Revision(s)

    Hearing Aid Services

  • Hearing Aid Services Codes – Moved analog an digitally programmable codes to "always requires auth" section -- no longer available on contract
  • Pharmacy Services Overview – New language for when a pharmacy may accept cash payment for prescriptions

    08/31/2011

    Addition(s)/Revision(s)

    Medication Therapy Management Services (MTMS) – MTM service now allowed in recipient's home

    08/26/2011

    Addition(s)/Revision(s)

    Equipment & Supplies

  • Standers – Clarified coverage of standers in nursing facilities
  • 08/25/2011

    Addition(s)/Revision(s)

    Immunizations & Vaccinations – Updated flu vaccine information and made one code clarification for 90715

    Pharmacy Services Overview – Updated the Table of Contents

    08/24/2011

    Addition(s)/Revision(s)

    Dental Services

  • Critical Access Dental Payment Program (CADPP) – 2011 Legislative changes to Critical Access Dental Payment Program
  • Pharmacy Services Overview – Clarified text for DAW requirements when a generic is preferred

    08/23/2011

    Addition(s)/Revision(s)

    Provider Basics

  • Authorization – Removed outdated fax number
  • Pharmacy Services Overview – Clarified the use of the Prescribing Provider NPI

    08/18/2011

    Addition(s)/Revision(s)

    Child and Teen Checkups (C&TC) – Added AAP FVA links. Moved legal reference for Lead Screening under Legal References

    08/17/2011

    Addition(s)/Revision(s)

    Physician and Professional Services

  • Health Care Homes (HCH) – MN–ITS HCH Tier e-Tool function provider access added
  • 08/15/2011

    Addition(s)/Revision(s)

    Mental Health Services

  • Adult Day Treatment – Revised authorization section
  • 08/12/2011

    Addition(s)/Revision(s)

    Pharmacy Services – Added text and links for Medical Supplies and Equipment and information about the new Authorization medical review agent

    08/09/2011

    Addition(s)/Revision(s)

    Mental Health Services

  • Dialectical Behavior Therapy (DBT) – Added modifier HN for clinical trainees delivering DBT
  • Provider Basics

  • Payment Methodology – Hospital – Updated with 2011 legislative changes
  • Reproductive Health/OB-GYN

  • Minnesota Family Planning Program (MFPP) – Deleted the word “Essure” in the MFPP Sterilization table for code 58565 and updated the Referral to Other Providers section
  • 08/08/2011

    Addition(s)/Revision(s)

    Provider Basics

  • Out-of-State Providers – Updated for new medical review agent
  • Health Care Programs and Services Overview – Updated for Legislative prohibition on payments to providers outside the United States

    08/05/2011

    Addition(s)/Revision(s)

    Equipment & Supplies

  • Positive Airway Pressure – Updated to allow purchase of CPAP/BiPAP if primary insurance requires purchase
  • 08/02/2011

    Addition(s)/Revision(s)

    Personal Care Assistance (PCA) Services – Added QP policies and the QA policy in the supervision and eligible providers sections

    07/28/2011 – 08/02/2011

    Addition(s)/Revision(s)

    Equipment & Supplies

  • • All Equipment and Supplies sections (except for Ventilators) have been updated with new medical review agent information
  • 07/28/2011

    Addition(s)/Revision(s)

    Chiropractic Services – Updated with new medical review agent information

    Eyeglass and Vision Care Services – Updated with new medical review agent information

    Hearing Aid Services – Updated with new medical review agent information

    Transportation Services Overview

  • Ambulance Transportation Services – Updated with new medical review agent information
  • 07/26/2011

    Addition(s)/Revision(s)

    Free-Standing Birth Center Services – Clarified information for billing recipient transfers

    Immunizations and Vaccinations – Clarified admin code requirements and pricing for admin

    Provider Basics

  • Program HH (HIV/AIDS) Covered Services – Updated for new medical review agent. Deleted information about Program HH mental health services requiring prior authorization
  • Transportation Services Overview – Updated with new medical review agent information

    07/25/2011

    Addition(s)/Revision(s)

    EW and AC

    07/22/2011

    Addition(s)/Revision(s)

    EW and AC

    Mental Health Services

  • Psychotherapy – Rule 47 revisions, clarification of progress notes
  • 07/15/2011

    Addition(s)/Revision(s)

    Authorization – Updated for new medical review agent, effective 7/1/2011; added additional fax number 1-866-465-8113

    07/07/2011

    Addition(s)/Revision(s)

    Authorization

  • Drug Authorizations – Updated for new medical review agent
  • MHCP Pharmacy Quick Reference – Updated for new medical review agent
  • 07/06/2011

    Addition(s)/Revision(s)

    Mental Health Services

  • Diagnostic Assessment – Revised for Rule changes and added links to Minnesota Rules 9505.0370, 0371, and 0372
  • 06/30/2011

    Addition(s)/Revision(s)

    Authorization – Updated for new medical review agent

    Dental Services (Overview)

  • Authorization Requirement Tables for Children and Pregnant Women – Updated authorization text
  • Children and Pregnant Women – Updated Oral Surgery criteria
  • Non-Pregnant Adults – Updated Oral Surgery criteria
  • Equipment & Supplies

  • Ambulatory Assist Equipment – Updated for new medical review agent
  • Bath and Toilet Equipment – Updated for new medical review agent
  • Provider Basics

  • Program HH Dental Authorization Requirement Chart – Updated for new medical review agent
  • 06/29/2011

    Addition(s)/Revision(s)

    Mental Health Services

    Partial Hospitalization Program – Added LOCUS information and added link to Minnesota Rules 9505.0370 to 9505.0372

    06/28/2011

    Addition(s)/Revision(s)

    Mental Health Services

  • Dialectical Behavior Therapy (DBT) – New section and added links to Minnesota Rules 9505.0370 and 0372
  • Explanation of Findings – Updated to implement rule change and added links to Minnesota Rules 9505.0370 and 0372
  • Mental Health Medication Management – Changed the Medication Management definition to comply with rule; added legal references; and added links to Minnesota Rules 9505.0370 and 0372
  • 06/27/2011

    Addition(s)/Revision(s)

    Hearing Aid Services

  • Hearing Aid Services Codes – Moved code V5120 for a body worn aid up by the other body worn aids
  • 06/23/2011

    Addition(s)/Revision(s)

    Mental Health Services

  • Intensive Residential Treatment Services (IRTS) – Updated section to match current rules and requirements
  • Rehabilitative Services – Added 59 modifier billing information

    06/16/2011

    Addition(s)/Revision(s)

    Day Training and Habilitation (DT&H) – Changed appropriate references to ICF/DD

    Elderly Waiver (EW) and Alternative Care (AC) Program

    Individualized Education Program (IEP) Services – Changed appropriate references to ICF/DD

    06/14/2011

    Addition(s)/Revision(s)

    Clinic Services

  • Federally Qualified Health Center and Rural Health Clinics – Added Nurse Midwife to FQHC/RHC encounter generating list of professionals
  • 06/08/2011

    Addition(s)/Revision(s)

    Dental Services (Overview)

    06/07/2011

    Addition(s)/Revision(s)

    Health Care Programs and Services Overview – Added GAMC end date; added example when recipient is covered by two programs; clarified newborn coverage policy; clarified persons incarcerated policy

    06/01/2011

    Addition(s)/Revision(s)

    Equipment & Supplies – Added language about new versus used equipment

    Mental Health Services

  • Diagnostic Assessment – Added text under the Billing section “due to complex needs as identified above”
  • 05/31/2011

    Addition(s)/Revision(s)

    Equipment & Supplies

  • Lower Limb Prosthetics – New sub section
  • Pharmacy Services – Corrected phone number to MHCP Provider Call Center

    05/26/2011

    Addition(s)/Revision(s)

    Mental Health Services

  • Diagnostic Assessment – Removed link and text to outdated “Who Can Do Mental Health Diagnostic Assessments and Psychotherapy?” chart
  • 05/24/2011

    Addition(s)/Revision(s)

    Provider Basics

  • Billing Policy (Overview) – Updated Void claim information to include claims over 3 years and terminated providers
  • 05/16/2011

    Addition(s)/Revision(s)

    Chiropractic ServicesAdded authorization/documentation criteria

    05/11/2011

    Addition(s)/Revision(s)

    Clinic Services Removed Federally Qualified Health Center and Rural Health Clinics information and made it its own section

    04/25/2011

    Addition(s)/Revision(s)

    Provider Basics

  • Provider Screening Requirements – Made correction to referring/ordering providers
  • 04/19/2011

    Addition(s)/Revision(s)

    Ambulatory Surgical ServicesUpdated information and formatting

    Chiropractic ServicesCorrected new threshold limit and removed GAMC reference

    Transportation Services Overview

  • Acceptable Ambulance Diagnosis Codes – Updated two diagnosis code list spans for the A0429 service code. Spans updated to 782.0 thru 782.5 and 796.2 thru 796.4
  • 04/13/2011

    Addition(s)/Revision(s)

    Dental Services (Overview)

  • Children and Pregnant Women – Changed appropriate references to ICF/DD and updated authorization links
  • 04/12/2011

    Addition(s)/Revision(s)

    Physician and Professional Services

  • Health Care Homes – Clarification made under Eligible Providers
  • Rehabilitative Services

  • Augmentative Communication Devices – Removed GAMC/CCDS text
  • 04/11/2011

    Addition(s)/Revision(s)

    Clinic Services – Updated chart under Billing for PHNC Services

    Equipment & Supplies

  • Bath and Toilet Equipment – Removed reference to modifier 22 and the effective date of 04/01/2010 for use of modifier U3 for clarification
  • 04/08/2011

    Addition(s)/Revision(s)

    Mental Health Services

  • Adult Rehabilitative Mental Health Services (ARMHS) – Added LOCUS and Functional Assessment information
  • Reproductive Health/OB-GYN

  • Sterilization – Changed appropriate references to ICF/DD
  • 04/07/2011

    Addition(s)/Revision(s)

    Pharmacy Services

  • NCPDP Payer Sheets Guidelines – Added the Other Payer ID Qualifier 03 BIN for field 6C and added the clarification of NCPDP to the reject codes in for other coverage code 03 in field 6E
  • 04/05/2011

    Addition(s)/Revision(s)

    Mental Health Services

  • Adult Crisis Response Services – Corrected community intervention 90882 unit length
  • 04/04/2011

    Addition(s)/Revision(s)

    Pharmacy Services Overview – Removed reference to CDMI as the prior authorization review agent for prescription drugs

    04/01/2011

    Addition(s)/Revision(s)

    Day Training and Habilitation (DT&H)Changed appropriate references to ICF/DD

    03/31/2011

    Addition(s)/Revision(s)

    Nursing FacilitiesChanged appropriate references to ICF/DD

    03/24/2011

    Addition(s)/Revision(s)

    Hearing Aid ServicesAdded language to clarify requirements for replacing hearing instruments

    03/23/2011

    Addition(s)/Revision(s)

    Child and Teen Checkups (C&TC) – Added disclaimer under Legal References

    Equipment & Supplies

  • Specialized Wound Treatment Technology – Added criteria for NPWT for acute wounds
  • Mental Health Services

  • Assertive Community Treatment (ACT) – Added LOCUS and Functional Assessment information and links
  • 03/21/2011

    Addition(s)/Revision(s)

    Reproductive Health/OB-GYN

  • Obstetric Services – Added information on E0604, hospital grade breast pumps: 3 month rental limit & a PA required for an additional month
  • 03/18/2011

    Addition(s)/Revision(s)

    Hospice ServicesDeleted obsolete information; updated format and reference to DD

    Transportation Services Overview

  • Special Transportation Services (STS) – Made clarifications and added a link to STS Procedure Codes & Payment Rates
  • 03/16/2011

    Addition(s)/Revision(s)

    Equipment & SuppliesUpdated policy regarding MUEs for prosthetics and orthotics

    Pharmacy Services

  • NCPDP Payer Sheets Guideline – Updated/clarified qualifier information for pharmacy COB reporting
  • 03/15/2011

    Addition(s)/Revision(s)

    Elderly Waiver (EW) and Alternative Care (AC) ProgramChanged appropriate references to ICF/DD

    Equipment & Supplies

  • Positive Airway Pressure for Treatment of Obstructive Sleep Apnea – Added information about suggested methods of compliance for CPAP and BI-PAP equipment within the 3rd month
  • Home Care Services

  • Skilled Nurse Visit (SNV) Services – Changed appropriate references to ICF/DD
  • Laboratory/Pathology, Radiology & Diagnostic Services

  • Authorization Requirements: Imaging Services – Clarified that authorization for emergency services in an ambulatory surgical center (ASC) or outpatient hospital setting is no longer required.
  • Pharmacy Services

  • Pharmacy Non-Controlled Substance Overrides – Changed appropriate references to ICF/DD
  • Relocation Service Coordination—Targeted Case Management (RSC—TCM)Changed appropriate references to ICF/DD

    Transportation Services Overview – Changed appropriate references to ICF/DD

  • Access Transportation Services (ATS) – Changed appropriate references to ICF/DD
  • 03/14/2011

    Addition(s)/Revision(s)

    HCBS-Waiver-Services – Changed appropriate references to ICF/DD

    Pharmacy Services

  • Pharmacy Controlled Substance Overrides – Changed appropriate references to ICF/DD
  • 03/10/2011

    Addition(s)/Revision(s)

    Laboratory/Pathology, Radiology & Diagnostic Services

  • Radiology/Diagnostic Services – Changed effective dates for services under Authorization Requirements
  • 03/08/2011

    Addition(s)/Revision(s)

    Billing Policy

  • Payment Methodology - Non-Hospital – Updated the vaccines rate methodology
  • 03/07/2011

    Addition(s)/Revision(s)

    Billing Policy

  • Payment Methodology - Non-Hospital – Changed appropriate references to ICF/DD
  • Prepaid Minnesota Health Care Programs (PMHCP) – Changed appropriate references to ICF/DD

    03/04/2011

    Addition(s)/Revision(s)

    Laboratory/Pathology, Radiology & Diagnostic Services

  • Radiology/Diagnostic Services – Providers performing certain imaging services will receive an immediate approved authorization response if the ordering/referring provider completed clinical decision support through a DHS approved vendor (Nuance) or if age, diagnosis and medical history are met. All other providers will answer medical criteria questions related to the requested procedure and based on their response may receive an immediate approved authorization.
  • 03/03/2011

    Addition(s)/Revision(s)

    HCBS Waiver Services – Added the new specialized supplies and equipment policy, oral and enteral nutritional products and responsibilities to the specialized supplies and equipment section

    ICF/DD – Changed appropriate references to ICF/DD; deleted obsolete language

    03/01/2011

    Addition(s)/Revision(s)

    Billing Policy

  • How to Read Your PDF RA – Corrected supplemental data information
  • Health Care Programs and Services

  • MHCP Benefits At-a-glance Changed appropriate references to ICF/DD
  • Rehabilitative Services – Changed appropriate references to ICF/DD

    Transportation Services

  • Ambulance Transportation Services – Changed appropriate references to ICF/DD
  • 02/25/2011

    Addition(s)/Revision(s)

    Provider Requirements Changed appropriate references to ICF/DD; deleted Rule 101 information (now separate page); added link to Billing Organization Responsibilities

  • Access Services – Added clarifier 'if provider cannot communicate with recipient' and for IEP providers to bill interpreter services per IEP section
  • Provider Participation Requirements – Rule 101 – Consolidated Rule 101 information
  • 02/23/2011

    Addition(s)/Revision(s)

    Equipment & SuppliesChanged appropriate references to ICF/DD, deleted obsolete language

  • Gloves – Changed appropriate references to ICF/DD
  • Mobility Devices Changed appropriate references to ICF/DD, deleted obsolete language
  • Patient Lifts and Seat Lift Mechanisms – Changed appropriate references to ICF/DD
  • Mental Health Services – OverviewUpdated Mental Health continuum graphic

    Rehabilitative Services

  • Service Thresholds (OT, PT, Speech-Language Pathology) – Updated threshold descriptions (units vs. treatment sessions) and changed threshold for biofeedback codes
  • 02/22/2011

    Addition(s)/Revision(s)

    Billing Policy

  • Payment Methodology - Non-Hospital – Updated anesthesia payment methodology
  • Transportation Services

  • Access Transportation Services – Removed older date references in the Overview section
  • 02/18/2011

    Addition(s)/Revision(s)

    Rehabilitative Services – Added clarification of professional documentation guideline under Documentation Requirements

    02/17/2011

    Addition(s)/Revision(s)

    Hearing Aid Services Codes TableAdded criteria for hearing aid repair authorization required for repair costs over $400

    02/15/2011

    Addition(s)/Revision(s)

    Elderly Waiver (EW) and Alternative Care (AC) ProgramChanged code X5467 to T2029 under Specialized Supplies and Equipment

    Equipment & Supplies

  • Pneumatic Compression Devices – Clarified that E0675 is not covered under Non-Covered Services
  • 02/10/2011

    Addition(s)/Revision(s)

    Community Health Worker Added MH professionals to the list of eligible providers

    Equipment & Supplies

  • Diabetic Equipment & Supplies – Added blood glucose monitors might need diagnosis under Covered Services
  • Pneumatic Compression Devices – Added E0656, E0657 are not reimbursed separately from the compressor under Non-Covered Services
  • 02/09/2011

    Addition(s)/Revision(s)

    Hospital ServicesAdded clarification notes to the MHCP Coverage Ended During Inpatient Stay subsection

    02/08/2011

    Addition(s)/Revision(s)

    Personal Care Assistance (PCA) Services – Added PCA Portal policies under PCA Agency enrollment section

    02/02/2011

    Addition(s)/Revision(s)

    Health Care Programs and ServicesAdded subsection Emergency Medical Assistance (EMA) Service Limitations

    Hospital ServicesAdded MHCP Coverage Ended During Inpatient Stay under Inpatient Billing sub section

    Provider Manual Table of Contents – Added EMA Service Limitations under Programs and Services

    Provider Requirements – Removed Access Services information

    01/31/2011

    Addition(s)/Revision(s)

    Child and Teen Checkups (C&TC) – Corrected title for Screening for Autism in Toddlers, Developmental Health and Mental Health

    01/27/2011

    Addition(s)/Revision(s)

    Provider Requirements

  • Access Services – New subsection; updated information about modifiers for interpreter services; added legislative requirement that interpreters must be on MDH Roster list
  • Hearing Aid ServicesClarified text for policy surrounding hearing aid replacement when lost or broken and authorization requirements for lost or damaged hearing aids

    01/25/2011

    Addition(s)/Revision(s)

    Transportation Services (Overview) – Clarified information regarding STS. Deleted verbiage referencing Local Trade Area

    01/24/2011

    Addition(s)/Revision(s)

    Rehabilitative Services

  • Service Thresholds (Occupational Therapy, Physical Therapy, Speech-Language Pathology) – Added modifiers to sections of the rehab threshold chart
  • 01/20/2011

    Addition(s)/Revision(s)

    Billing Policy

  • Medicare and Other Insurance – Clarified providers must verify if a policy is a Medicare replacement policy; and insurance includes long term care insurance
  • Physician and Professional Services

  • Primary Care Coordination (PCC) – Added the word rendered under Eligible Providers
  • 01/19/2011

    Addition(s)/Revision(s)

    Equipment & Supplies – Added link to Breast Pumps to the Table of Contents

    01/18/2011

    Addition(s)/Revision(s)

    Anesthesia Services – Updated with the new 2011 anesthesia formulas

    Immunizations & Vaccinations – Updated recipient eligibility; clarified coverage, including vaccines/toxoids and administration charts

    Rehabilitative Services

  • Augmentative Communication Devices – Added clarifying language about repairs on devices that have been modified by the recipient
  • 01/12/2011

    Addition(s)/Revision(s)

    Reproductive Health/OB-GYNChange title of Birth Center Services section to Free-Standing Birth Center Services

    01/11/2011

    Addition(s)/Revision(s)

    Personal Care Assistance (PCA) Services – Added text from the assurance statement to the PCA about non-compete clause use for individual PCAs who have left the agency

    Rehabilitative Services

  • Orthotic Procedures – Updated chart with new L-codes
  • 01/10/2011

    Addition(s)/Revision(s)

    Rehabilitative Services – Removed Augmentative Communication Devices information and created new subsection

    01/07/2011

    Addition(s)/Revision(s)

    Authorization – Added new subsection Drug Authorization

    01/05/2011

    Addition(s)/Revision(s)

    Personal Care Assistance (PCA) Services – Removed recipient criteria under Eligible Recipients

    Pharmacy Services Overview – Added information pertaining to Health Information Designs (HID), the new MHCP Prescription Drug PA review Agent

    Provider Requirements

    Rehabilitative Services

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