MHCP Clinical Care Consultation: Frequently Asked Questions (FAQs)

For more information, see Clinical Care Consultation in the MHCP Provider Manual.

Benefits

Billing

Documentation

Services Provided

Benefits

Q. Is this a fee–for-service Medical Assistance benefit or a benefit within Prepaid Medical Assistance Programs (PMAP)?
A. This is a benefit for children enrolled in all Minnesota Health Care Programs (MHCP), including Medical Assistance fee-for-service and PMAP, as well as MinnesotaCare.

Q. How are the timed ranges counted toward the benefit limit of 15 hours per calendar year before authorization is required?
A. The upper limit of the range of consultation billed is counted toward the benefit limit. For example, if billing the 5- to 10-minute code and modifier, 10 minutes will count toward the benefit limit. For the 30+ minute code, 50 minutes will count toward the benefit limit. MHCP uses 50 minutes to establish the rate for this level of service delivery.

Billing

Q. Will it be necessary to bill primary insurance for denial before billing to MHCP?
A.Yes. You must first bill the service to the primary insurance.

Q. Can we bill retroactively?
A. Yes. You may bill for this service back to January 1, 2015, as long as the coverage criteria are met (including documentation).

Q. If two mental health professionals render clinical care consultation for the same client, can they both bill for their time?
A. Yes. However, they need to split the time into two billable amounts comprising the total amount of time.

Q. Can email communications be billed under this service?
A. No. You must provide services either face-to-face, including telemedicine, or by telephone.

Q. Do NCCI (National Correct Coding Initiative) Edits apply to this code?
A. Not at this time, but check the Centers for Medicare & Medicaid Services (CMS) website frequently.

Documentation

Q. What documentation does the medical record need to contain to verify a recipient meets the definition of complex as defined in Minnesota Rules 9505.0372, Subpart 1, C or co-occurs with other complex and chronic health conditions?
A. You may document client complexity in one of these three ways:

1. In an extended diagnostic assessment

2. As an addendum to a standard diagnostic assessment

3. As an addendum to the individual treatment plan

Services Provided

Q. Are these services in Children’s Therapeutic Services and Supports (CTSS)?
A. No. These services exist as outpatient services and cannot be billed under CTSS.

Q. Is there a distinction between a treating professional and a supervising professional?
A. The treating professional is the mental health professional or treating clinical trainee providing psychotherapy to the child or family. A supervising professional is the mental health professional who supervises clinical trainees but does not provide psychotherapy to the child or family. Only a treating professional or treating clinical trainee can bill for these services.

Q. What is the difference between psychiatric consultation to primary care and clinical care consultation?
A. Psychiatric consultation is a different service from clinical care consulation. Psychiatric consultation has the following main components: 1) it is initiated by primary care; 2) the child is not served by psychiatry and instead may be seeing primary care for a psychotropic medication assessment or medication monitoring, and 3) the consultation is meant to ensure that primary care is providing the most supportive medical care and possible mental health referrals to children who may qualify for a mental health diagnosis, but are not currently accessing psychiatry.

In clinical care consultation, the child is being served by both psychiatry and primary care and the purpose is to provide information to the primary care physician to help the child and the family achieve treatment goals. Thus, both the psychiatrist and primary care physician would both be treating the child in clinical care consultation.

Q. Can a treating mental health professional bill clinical care consultation to others who work with the child within the same agency?
A. Yes. Other mental health professionals in the same agency, such as a psychiatrist and psychotherapist, would need to split the time.

Q. Can a treating mental health professional bill clinical care consultation when providing clinical care consultation to those in the same agency who are providing CTSS skills services to the child?
A. No. Regardless if the mental health professional is the skills worker’s clinical supervisor or not, clinical care consultation in this instance is the same as clinical supervision and could not be billed as clinical care consultation.

Q. If a treating mental health professional consults with three different providers about the same child in the same day should the treating professional “pool the time?”
A. Yes. The treating mental health professional or treating clinical trainee (psychotherapist) should bill one claim line for 15 minutes (5 min x 3 times). However, the psychotherapist must write three separate notes for the three separate consultations with the required elements.

Q. Can clinical care consultation be provided to foster parents?
A. No. Foster parents are considered caregivers, not professionals, and may receive family psychotherapy.

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