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Substance Use Disorder Services (SUD)

Revised: January 1, 2019

  • Overview
  • Eligible Providers
  • Eligible Recipients
  • Covered Services
  • Noncovered Services
  • Billing
  • Legal References
  • Overview

    Publicly paid substance use disorder (SUD) treatment services may be delivered through either managed care or fee-for–service.

  • • Funding for substance use disorder (SUD) services are covered by the Consolidated Chemical Dependency Treatment Fund (CCDTF) for Medical Assistance (MA) and MinnesotaCare fee-for-service payment.
  • • People who are not enrolled with a Minnesota Health Care Program (MHCP) can receive payment of services through the CCDTF if they meet CCDTF income and household size guidelines. (CCDTF Service Rate Grid with Dollar Amounts effective 1-1-2019 (DHS-7612) (PDF)
  • Minnesota Substance Use Disorder Reform

    In 2017, SUD reform added services to the state’s Medicaid benefit set and provided a more streamlined process for accessing SUD services.

  • • Reimbursement of three new services (Comprehensive Assessment, Treatment Coordination, and Peer Recovery services)
  • • How to add newly eligible vendors of SUD services, including individuals in private practice, counties and tribes, and recovery community organizations.
  • Eligible Providers

    To provide, bill and receive payment for SUD services a provider must:

  • • Be enrolled as a Minnesota Health Care Program (MHCP) provider for alcohol and drug abuse
  • • Meet all provider qualifications as stated on the assurance statement for the provider type.
  • • Enroll and participate in the Drug and Alcohol Abuse Normative Evaluation System (DAANES). As a SUD treatment provider, you will not receive reimbursement unless you have complied with the DAANES requirements for each CCDTF recipient. All SUD clients regardless of funding need to be entered into DAANES for each admission episode. Contact the DAANES office by email or call 651-431-2631 to obtain the necessary training and documents required to participate in DAANES.
  • Eligible providers include the following:

  • • Residential SUD treatment programs
  • • Nonresidential (outpatient) SUD treatment programs
  • • Counties and tribes
  • • Recovery Community Organizations (RCO)
  • • Hospitals
  • • Qualified Substance-use disorder professional
  • • Medication-assisted treatment program
  • Provider Type Home Page Links
    Review related webpages for the latest news, additions, forms and quick links:

  • Eligible Recipients

    SUD services are available to MHCP members. Some people not enrolled with MHCP may also access SUD services through CCDTF if they meet CCDTF clinical and financial eligibility requirements. CCDTF financial eligibility determinations are made by a Rule 25 assessor or by the member’s county of residence. Clinical eligibility is determinced via the Rule 25 assessment or Direct Access- or all MHCP funded SUD services.

    For a person to be eligible to get substance use disorder treatment they must meet MHCP income guidelines (DHS-3461A) (PDF) and CCDTF financial eligibility guidelines.

    Individuals having private or publicly funded medical insurance may qualify for CCDTF payment if their insurance does not fully cover SUD treatment services. This may include copays, coinsurance, or a deductible.

    Individuals enrolled with an MHCP contracted managed care organization (MCO) must contact their MCO for details on coverage and accessing SUD services.

    Covered Services

    Covered services must be delivered as outlined in the Minnesota Statutes. Each facility must be enrolled as an eligible provider of specific services, specialties, or complexity add-ons to receive reimbursement from MHCP. Providers are responsible to know and understand the rules and regulations pertaining to any services they submit for reimbursement. See the CCDTF Service Rate Grid for service and complexity add-on rates.

    SUD services that can be reimbursed include the following:

  • • Hospital-based inpatient treatment
  • • Room and Board only
  • • Comprehensive assessment
  • • Treatment Coordination
  • • Recovery peer support
  • • Medication assisted therapies (MAT). MAT services may also be included as an add-on to the per diem of residential treatment services. MAT services are reimbursed on a per diem basis and may include:
  • • MAT-Methodone
  • • MAT-all other
  • • MAT-Methadone-PLUS
  • • MAT-all other-PLUS
  • Noncovered Services

    The following are not covered:

  • • Rule 25 chemical use assessments
  • • Services delivered before the completion of a Rule 25 or Comprehensive Assessment
  • • Room-and-board services not clinically or medically necessary
  • • Services delivered to people with MHCP managed by an MCO, with the exception of room and board services.
  • • Detoxification services
  • • More than one treatment service for the same person, for the same date span, provided by the same provider, except for nonresidential group and individual guest dosing
  • A county may choose to pay 100 percent of any service that MHCP does not cover.

    Billing

    Refer to the Rate Reform Grid with Dollar Amounts (DHS-7612) (PDF) document for possible enrolled service combinations and rates.

    CCDTF-Authorized Services

    The service agreement (SA) letter generated when a county or tribe makes a CCDTF authorization contains most of the information you will need to bill MHCP for CCDTF-authorized services. You must:

  • • Review the information in the SA letter for accuracy (procedure codes and modifiers, dates, rates, number of units, etc.).
  • • Contact the authorizing county or tribe if you believe that you received an incorrect SA letter and obtain a corrected SA letter before billing.
  • • Report the approved SA rate for the service provided on the claim service line (reporting other rates may result in an inaccurate unit decremented from the SA).
  • See the MN–ITS User Guides for instructions on how to submit electronic claims. Use the following electronic claim formats for the program types when billing MHCP for CCDTF-authorized services.

    Claim formats for program types

    Program Type

    Electronic Claim Format

    Inpatient hospital based

    837I (institutional)

    Residentially licensed (daily units)

    837I (Institutional)

    Room and board only (daily units)

    837I (Institutional)

    Nonresidential (hourly units)

    837I (Institutional) or 837P (Professional)

    Medication-assisted therapy (daily units)

    837P (Professional)

    Revenue and Procedure Codes

    The following tables describe the codes to use when billing MHCP for CCDTF-authorized services.

    Service Description

    Unit

    Revenue Code

    HCPCS Procedure Code

    Claim Format

    Type of Bill

    Service Limitations

    Inpatient hospital – bundled room and board and treatment

    Day

    0101

    None

    837I

    11X

    Per diem

    Inpatient hospital – room-and-board component only

    Day

    0118
    0128
    0138
    0148
    0158

    None

    837I

    11X

    Per diem

    Inpatient hospital – treatment component only

    Day

    0944
    0945

    None

    837I

    11X

    Per diem

    Residential program – room-and-board component only

    Day

    1002

    None

    837I

    86X

    Per diem

    *Residential program – treatment component only

    Day

    0944
    0945
    0953

    None

    837I

    86X

    Per diem

    Freestanding room and board

    Day

    1003

    None

    837I

    86X

    Per diem

    Outpatient individual (nonresidential) treatment

    Hour

    0944
    0945
    0953

    H2035

    837I or 837P

    89X or 13X

    10 units per day

    Outpatient group (nonresidential) treatment

    Hour

    0944
    0945
    0953

    H2035 with modifier HQ

    837I or 837P

    89X or 13X

    3 units per day

    **Nonresidential treatment – medication-assisted therapy (all other)

    Day

    H0047

    837P

    Per diem

    **Nonresidential treatment – medication-assisted therapy plus (all other)

    Day

    H0047 with modifier UB

    837P

    Per diem

    **Nonresidential treatment – medication-assisted therapy (methadone)

    Day

    H0020

    837P

    Per diem

    **Nonresidential treatment – medication-assisted therapy plus (methadone)

    Day

    H0020 with modifier UA

    837P

    Per diem

    Treatment Coordination

    15 minute

    0944
    0945
    0953

    T1016 with modifier U8 HN

    837I or 837P

    89X or 13X

    8 units per day

    Peer Support Specialist

    15 minute

    0944
    0945
    0953

    H0038 with modifier U8

    837I or 837P

    89X or 13X

    8 units per day

    Comprehensive Assessment

    0944
    0945
    0953

    H0001

    837I or 837P

    89X or 13X

    2 allowable every rolling 6 months.

    *Note: Assessments may be billed as Outpatient individual (nonresidential) treatment if limitation is exceeded.

    Interim Billing

    Effective for date of service on or after Jan. 1, 2019, bill residential and inpatient hospital claims that span multiple months using intrim billing method. Include the date of discharge on the final treatment claim along with appropriate patient status code.

    Nonresidential clinic billing

    Bill nonresidential medication-assisted therapy (MAT) and MAT Plus using the professional (837P) claim format. Report the appropriate place of service to distinguish on-site dosage(s) from take-home dosage(s). Itemize dosages by listing each date of service on a separate service line.

    Additional Billing Information

    Medicare

    Certified Medicare facilities serving Medicare-eligible clients must follow the MHCP Medicare policy found in the MHCP Provider Manual; see Medicare and Other Insurance under Billing Policy.

    Third-Party Liability (TPL)

  • • MHCP TPL policy applies to all SUD treatment providers. When a recipient has private, commercial insurance for an authorized treatment placement, you must first bill the private, commercial insurance before billing MHCP.
  • • Check MN–ITS before submitting bills to MHCP. If MN–ITS indicates that TPL exists for the date(s) that you would like to bill for, then you must first bill the third party displayed in MN–ITS for the date(s). If you bill MHCP for dates of service when TPL exists, MHCP will deny the claim.
  • • After billing the third party, submit appropriate documentation to MHCP. You must follow the MHCP TPL policy found in the MHCP Provider Manual; see “Third Party Liability (TPL)” in Medicare and Other Insurance under Billing Policy.
  • Legal References

    Minnesota Statutes, section 254A.03 (Alcohol and Drug Abuse)
    Minnesota Statutes, Chapter 254B
    (Consolidated Chemical Dependency Treatment Fund)
    Minnesota Statutes, section 256B.031
    (Prepaid Health Plans)
    Minnesota Statutes, section 256L
    (MinnesotaCare)
    Minnesota Rules, parts 9530.6600 to 9530.6655
    (Rule 25)
    Minnesota Rules, parts 9530.6800 to 9530.7030
    (Rule 24)
    Minnesota Rules, parts 9530.6405 to 9530.6505
    (Rule 31)
    Minnesota Rules, parts 9530.6510 to 9530.6590
    (Rule 32)
    Minnesota Rules, part 9530.6615, subp. 2
    (Rule 25, Staff Performing Assessment)
    Minnesota Rules, part 9530.6605, subp. 21a
    (Rule 25, Definitions, Placing Authority)
    42 Code of Federal Regulations, section 440.130(d)

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    © 2019 Minnesota Department of Human Services Updated: 1/4/19 12:21 PM | Accessibility | Terms/Policy | Contact DHS | Top of Page | Updated: 1/4/19 12:21 PM