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Children’s Therapeutic Services and Supports (CTSS)

Revised: 10-25-2016

  • Overview
  • Eligible Providers
  • Eligible Recipients
  • Covered Services
  • Authorization
  • Billing
  • Legal Reference
  • Overview

    CTSS is a flexible package of mental health services for children who require varying therapeutic and rehabilitative levels of intervention. CTSS addresses the conditions of emotional disturbance that impair and interfere with an individual’s ability to function independently. For children with emotional disturbances, rehabilitation means a series or multidisciplinary combination of psychiatric and psychosocial interventions to:

  • • Restore a child or adolescent to an age-appropriate developmental trajectory that had been disrupted by a psychiatric illness; or
  • • Enable the child to self-monitor, compensate for, cope with, counteract, or replace psychosocial skills, deficits or maladaptive skills acquired over the course of a psychiatric illness.
  • Psychiatric rehabilitation services for children combine psychotherapy to address internal psychological, emotional and intellectual processing deficits with skills training to restore personal and social functioning to the proper developmental level. Psychiatric rehabilitation services establish a progressive series of goals with each achievement building upon a prior achievement. Continuing progress toward goals is expected, and rehabilitative potential ceases when successive improvement is not observable over a period of time. CTSS services are delivered using various treatment modalities and combinations of services designed to reach measurable treatment outcomes identified in an individual treatment plan (ITP).

    Eligible Providers

    CTSS providers are enrolled MHCP providers certified to provide CTSS mental health rehabilitation services. The following entities may request MHCP certification as CTSS providers:

  • • County-operated entities
  • • Community mental health centers (CMHCs)
  • • Hospital-based providers
  • • Indian health services and 638 facilities
  • • Non-county mental health rehabilitative providers
  • • School districts (Options 2 & 3: see Individualized Education Program (IEP) Services)
  • School-based providers

    Schools choose from one of three CTSS options:

  • 1. Option 1: IEP evaluation notification (not a CTSS certification process)
  • 2. Option 2: Contract CTSS - the school chooses to contract mental health services from a CTSS certified community provider
  • 3. Option 3: School CTSS - the school employs mental health staff
  • Schools have differences in billing codes and authorization process. See the IEP Billing and Authorization Requirements section of the Provider Manual for more information.

    Mental Health Professionals

    The following mental health professionals can provide CTSS:

  • Licensed Psychologist (LP)
  • Licensed Professional Clinical Counselor (LPCC)
  • Licensed Independent Clinical Social Worker (LICSW)
  • Licensed Marriage and Family Therapist (LMFT)
  • Psychiatry or an Osteopathic Physician
  • Clinical Nurse Specialist (CNS)
  • Psychiatric Nurse Practitioner (NP)
  • • Tribally approved mental health care professional who meets the standards in Minnesota Statutes, section 256B.02, subdivision 7, paragraphs (b) and (c), and who is serving a federally recognized Indian tribe.
  • Mental Health Practitioner

    Mental health practitioners may provide the following services under CTSS:

  • • Skills training
  • • Crisis assistance
  • • Direction of mental health behavioral aides (MHBA)
  • • Treatment plan development and review
  • • Administering and reporting standardized measures
  • Mental health practitioners who are qualified as clinical trainees may also provide psychotherapy.

    Requirements

    Refer to General MHCP Non-Enrollable Mental Health Provider Requirements (see the Non-Enrollable Providers Training & Continuing Education Requirements section) for additional practitioner requirements.

    CTSS Certification

    Providers must be certified prior to delivering CTSS services. Certification involves approval and acceptance of the provider agency’s application based on whether the agency meets the statutory standards. Initial certification may be for one to three years. Prior to applying for certification, potential CTSS agency providers must attend the following trainings:

  • • CTSS Administrative
  • • CTSS Clinical
  • Registration information, training dates and materials can be found under CTSS Applicant Provider Information Session on the Children’s Mental Health-Training Information page.

    The following three documents were developed for the CTSS application and certification process:

  • Children’s Therapeutic Services and Supports Provider Certification Process (DHS-3622) (PDF)
  • Children’s Therapeutic Services and Supports Provider Entity Application Guideline (DHS-3623) (PDF)
  • Children’s Therapeutic Services and Supports Provider Entity Primary Certification Application (DHS-3610) (PDF)
  • To be certified, providers must be able and certified to deliver the core services of:

  • • Psychotherapy
  • • Skills training
  • • Crisis assistance
  • • Treatment plan development and review
  • • Administering and reporting standardized measures
  • In addition, providers may be certified to provide:

  • • CTSS day treatment
  • • Mental health behavioral aide service
  • Initial certification may be limited to certification for core services. Day treatment or mental health behavioral aide services may be added later by submitting the CTSS addendum (DHS-4988) (PDF) application.

    Schools seeking certification must follow criteria on the Children’s Therapeutic Services and Supports Overview for Schools and School Districts (DHS-4982B) (PDF) and the IEP Billing and Authorization Requirements.

    Recertification

    Recertification requires reviewing Recertification Review Process (DHS-4978) (PDF) and submitting a Recertification Application (DHS-4979) (PDF). Recertification will include a site review to examine policies and procedures and clinical documentation of CTSS services.

    Decertification

    Upon the commissioner’s determination that a provider no longer meets the requirements in law or fails to meet the clinical quality standards or administrative standards provided in the application and certification process, the commissioner must require corrective action, Medical Assistance repayment, or decertification of the provider.

    Provider Responsibilities

    A certified CTSS provider must ensure that caseload size permits the provider to deliver services to both recipients with severe, complex needs and recipients with less intensive needs. The provider’s caseload size should reasonably enable the provider to play an active role in service planning, monitoring and delivering services to meet the recipient’s and family’s needs, as specified in each recipient’s individual treatment plan. Mental health professionals and practitioners providing CTSS must:

  • • Develop an ITP for necessary and appropriate care based on information in the child’s standard or extended diagnostic assessment and the documented input of the family and other authorized caregivers
  • • Sign the ITP (the child or legal guardian and mental health professional or clinical supervisor of the practitioner must sign the ITP before implementing service)
  • • Review the ITP at least every 90 days with the recipient and the recipient’s parents or guardians
  • • Ensure that the services provided are designed to meet specific mental health needs of the child and the child’s family according to the child’s ITP
  • • Coordinate CTSS services
  • • Work with other health care providers (including multiple agencies, if for example, the child has an additional diagnosis of developmental disability, substance abuse, or physical condition requiring regular medical care)
  • Eligible Recipients

    To be eligible for CTSS, recipients must meet all of the following criteria:

  • • Be under 21 years old
  • • Have a diagnostic assessment that documents:
  • • A primary diagnosis of an emotional disturbance for children under 18 years old or mental illness for young adults 18 through 20 years old
  • • Medical necessity for CTSS
  • • A completed CASII or ECSII
  • • Have a completed and signed individual treatment plan that:
  • • Documents specific goals and objectives for CTSS services
  • • Is signed by the supervising mental health professional and the parent or guardian prior to service delivery
  • The diagnostic assessment used to establish eligibility for CTSS must be done by a mental health professional or clinical trainee within 365 days before CTSS services begin.

    In addition to the general MHCP requirements for a Diagnostic Assessment (DA), CTSS requires that the DA:

  • • Include current diagnoses including any differential diagnosis, in accordance with all criteria for a complete diagnosis and diagnostic profile as specified in the current edition of the Diagnostic and Statistical Manual of the American Psychiatric Association, or, for children under five years old, as specified in the current edition of the Diagnostic Classification of Mental Health Disorders of Infancy and Early Childhood
  • • Document CTSS as medically necessary rehabilitation to address an identified disability or functional impairment, and the recipient’s needs and goals
  • • Be used in the development of the recipient’s ITP goals and objectives
  • • Be completed annually until child is 18 years old or updated annually for recipients 18 through 20 years old, unless a recipient’s mental health condition has changed markedly since the most recent diagnostic assessment
  • Covered Services

    The following services are billable as CTSS. Certified CTSS providers must provide or ensure the following services as prescribed in the child’s ITP. Required core services must be provided or offered by a certified community provider, while a school CTSS provider may choose which of the core services to deliver:

  • Psychotherapy - with patient or family member (or both), family, group and psychotherapy for crisis
  • Skills training - individual, family or group
  • Crisis assistance
  • • Treatment plan development and review
  • • Administering and reporting standardized measures
  • Optional services may be offered according to requirements below:
  • • MHBA services, including direction of the mental health behavioral aide
  • Children’s day treatment, a combination of psychotherapy and skills training
  • Psychotherapy

    Refer to Psychotherapy for additional information about this service. Psychotherapy to address the child's underlying mental health disorder must be documented as part of the child's ongoing treatment. A provider must deliver, or arrange for, medically necessary psychotherapy, unless the child's parent or caregiver chooses not to receive it. When a provider delivering other services to a child under CTSS deems it not medically necessary to provide psychotherapy to the child for a period of 90 days or longer, the provider must document the medical reasons why psychotherapy is not necessary. When a provider determines that a child needs psychotherapy but psychotherapy cannot be delivered due to a shortage of licensed mental health professionals in the child's community, the provider must document the lack of access in the child's medical record.

    Skills Training

    Skills training is medically necessary when the child has lost behavioral skills or failed to develop behavioral skills compared to others of similar age as a result of the child’s diagnosed mental health disorder. Skills training may also be delivered to help the youth to self-monitor, compensate for, cope with, counteract, or replace skills deficits or maladaptive skills acquired during the course of a psychiatric illness. Unlike a thought, feeling or perception, a skill is observable by others. It is an activity that must be practiced in order to be mastered and maintained. There are right ways and wrong ways to perform the skill. Typically, a skill is performed for a reason and a skill can be generalized and adapted to many different situations.

    Skills training is subject to the following requirements:

  • • A mental health professional clinical trainee or a mental health practitioner must provide skills training
  • • Skills training delivered to children or their families must be targeted to the specific deficits or maladaptations of the child's mental health disorder and must be prescribed in the child's individual treatment plan
  • • Skills training delivered to the child's family must teach skills needed by parents to enhance the child's skill development and to help the child use the skills and develop or maintain a home environment that supports the child's ongoing use of the skills
  • • Group skills training may be provided to multiple recipients who, because of the nature of their emotional, behavioral, or social dysfunction, can derive mutual benefit from interaction in a group setting, which must be staffed as follows:
  • • One professional or one clinical trainee or one practitioner under clinical supervision of a licensed mental health professional must work with a group of three to eight recipients
  • • Two professionals or two clinical trainees or two practitioners under clinical supervision of a licensed mental health professional, or one professional or one clinical trainee plus one practitioner must work with a group of nine to 12 recipients
  • • The mental health professional delivering or supervising the delivery of skills training must document any underlying psychiatric condition and must document how skills training is being used in conjunction with psychotherapy to address the underlying condition
  • • A mental health professional, clinical trainee or mental health practitioner must have taught the psychosocial skill before a mental health behavioral aide may practice that skill with the client
  • Crisis Assistance

    Crisis assistance is for the child, the child’s family and all providers of services to the child to:

  • • Recognize factors precipitating a mental health crisis
  • • Identify behaviors related to the crisis
  • • Be informed of available resources to resolve the crisis
  • Crisis assistance requires the development of a written plan that addresses prevention and intervention strategies in a potential crisis, including plans for:

  • • Actions the family should be prepared to take to resolve or stabilize a crisis
  • • Arranging admission to acute care hospital inpatient treatment
  • • Crisis placement
  • • Community resources for follow-up
  • • Emotional support to the family during crisis
  • Mental Health Behavioral Aide (MHBA)

    A MHBA is a paraprofessional working under the clinical supervision of mental health professionals (employed by the same CTSS provider or another CTSS agency). A MHBA implements the one-on-one MHBA services identified in a child’s ITP and individual behavior plan (IBP). A MHBA provides MHBA services.

    Requirements

  • • MHBA requirements are in the General MHCP Non-Enrollable Mental Health Provider Requirements table in the CTSS section. This section also includes pre-service and continuing education requirements.
  • MHBA Clinical Supervision: Clinical supervision of a mental health behavioral aide is guided by the same standards as those established for a mental health practitioner providing outpatient mental health services. A clinical supervision plan must be in place. In addition to clinical supervision requirements, CTSS entities that elect to provide MHBA services also must provide direction for MHBAs as described below.
  • Services
    MHBA services are medically necessary services designed to improve the functioning of the child in the progressive use of developmentally appropriate psychosocial skills. Activities involve working directly with the child, child-peer groupings, or child-family groupings to practice, repeat, reintroduce, and master the skills previously taught by a professional or clinical trainee or mental health practitioner including:

  • • Providing cues or prompts in skill-building peer-to-peer or parent-child interactions so that the child progressively recognizes and responds to the cues independently
  • • Performing as a practice partner or role-play partner
  • • Reinforcing the child's accomplishments
  • • Generalizing skill-building activities in the child's multiple natural settings
  • • Assigning further practice activities
  • • Intervening as necessary to redirect the child's target behavior and to de-escalate behavior that puts the child or other person at risk of injury
  • All services provided by a MHBA must be identified in an individual behavior plan (IBP). The IBP must be developed by the mental health professional or clinical trainee or by a mental health practitioner providing direction for the mental health behavioral aide.

    The child’s ITP must:

  • • Identify the need for MHBA services
  • • Determine the scope, duration and frequency of services required for the child and child’s family
  • Before an MHBA provides services, the mental health professionals must approve the IBP that details the:

  • • Instructions of the services the MHBA is expected to provide
  • • Time allocated to each service
  • • Methods of documenting the child’s behavior
  • • Methods of monitoring the progress of the child in reaching objectives
  • • Goals to increase or decrease targeted behavior as identified in the ITP
  • In accordance with IBP, the MHBA must:

  • • Implement activities in the child’s IBP
  • • Document the delivery of services and progress on objectives in progress notes
  • Direction of the MHBA
    Direction refers to the activities of mental health professionals, or mental health practitioners under the supervision of a mental health professional, to guide the work of the MHBA. The clinical supervisor must be employed by the certified CTSS agency or other provider certified to provide MHBA services to ensure necessary and appropriate oversight for recipient’s treatment and continuity of care. Direction of the MHBA is a covered service, clinical supervision is not.

    The mental health professional, clinical trainee or mental health practitioner working under the clinical supervision of a mental health professional providing direction must begin with the goals on the individualized treatment plan, and instruct the mental health behavioral aide on how to construct therapeutic activities and interventions that will lead to goal attainment. The professional or practitioner giving direction must also instruct the mental health behavioral aide about the recipient's diagnosis, functional status and other characteristics that are likely to affect service delivery. Direction must also include determining that the mental health behavioral aide has the skills to interact with the recipient and the recipient's family in ways that convey personal and cultural respect and that the aide actively solicits information relevant to treatment from the family. The aide must be able to clearly explain or demonstrate the activities the aide is doing with the recipient and the activities' relationship to treatment goals. Direction is more didactic than is supervision and requires the professional or practitioner providing it to continuously evaluate the mental health behavioral aide's ability to carry out the activities of the individualized treatment plan and the individualized behavior plan. When providing direction, the professional or practitioner must:

  • • Review progress notes prepared by the mental health behavioral aide for accuracy and consistency with diagnostic assessment, treatment plan and behavior goals and the professional or practitioner must approve and sign the progress notes
  • • Identify changes in treatment strategies, revise the individual behavior plan and communicate treatment instructions and methodologies as appropriate to ensure that treatment is implemented correctly
  • • Demonstrate family-friendly behaviors that support healthy collaboration among the child, the child's family and providers as treatment is planned and implemented
  • • Ensure that the mental health behavioral aide is able to effectively communicate with the child, the child's family, and the provider; record the results of any evaluation and corrective actions taken to modify the work of the mental health behavioral aide
  • Professional, clinical trainee and practitioner responsibilities in the direction of MHBAs includes all the following:
  • • A clinical supervision plan for the MHBA approved by the responsible mental health professional
  • • Ongoing on-site observation by a mental health professional or practitioner for at least one total hour every forty hours of service provided to each child
  • • Immediate accessibility of the professional, clinical trainee or practitioner to the MHBA during service provision
  • • Reviewing progress notes prepared by MHBA for accuracy and consistency with diagnostic assessment, treatment plan and behavior goals. Progress notes must be approved and signed by mental health professionals, clinical trainees or mental health practitioners
  • • Identifying changes in treatment strategies, revise the IBP and communicate treatment instructions and methodologies, as appropriate, to ensure that treatment is implemented correctly
  • • Demonstrating family friendly behaviors that support healthy collaboration among child, child’s family and providers as treatment is planned and implemented
  • • Ensuring that MHBAs are able to effectively communicate with the child, child’s family and the provider
  • • Recording the results of any evaluation and corrective actions taken to modify the work of MHBAs
  • Additional direction may be provided if a MHBA requires more frequent instruction to carry out the therapeutic activities identified in the ITP and IBP.

    Direction of MHBA is not counted toward CTSS threshold.

    Service Plan Development

    Service plan development covers two separately-billable activities: (a) individual treatment plan (ITP) development or treatment plan review and (b) functional assessment administration and outcomes reporting.

    Time and activities that may be billed under this benefit include the following:

  • 1. Formulating the individual treatment plan or treatment plan review
  • 2. Contacting and arranging with parents or guardians to develop, review and sign the ITP or ITP review if they are unable to participate at the same time as the treatment team
  • 3. Meeting with family or client and caregivers to review and address what is to be accomplished through CTSS services
  • 4. Making arrangements with external entities to make necessary resources available for implementing the ITP
  • 5. Administering and reporting required standardized measures to Children’s Mental Health Outcome Measures Reporting System
  • Individual treatment plan (ITP) and treatment plan review
    An individual treatment plan (ITP) is a written plan that documents the treatment strategy, the schedule for accomplishing the goals and objectives, and the responsible party for each treatment component. A treatment plan review (ITP review) is a review of progress and changes that have occurred during the 90 days since the initial ITP or previous ITP review was implemented. An ITP must be completed before mental health service delivery begins. An ITP review must be completed within 90 days after the ITP is implemented.

    An ITP for any CTSS service is based on a standard or extended diagnostic assessment. It documents the plan of care and guides treatment interventions. Development of the ITP includes involvement of the client, the client’s parents or guardian who must consent to the mental health services for the client, caregivers or others that the family determines should be included in ITP development and review. ITP development includes arrangement of treatment and support activities consistent with the client’s cultural and linguistic needs.

    The ITP focuses on the youth’s treatment needs, the family’s vision and desires for recovery in accordance with their personal and cultural values, family-driven and child-focused priority treatment goals and objectives, and the interventions that will help meet those goals and objectives. The plan must be written in a way that facilitates a clear understanding of the services being offered, that describes how the services will address client and family concerns, and that establishes goals and objectives that can be objectively measured for treatment outcomes. The child or youth and family must participate in developing the ITP to ensure the treatment is relevant to their priorities and incorporates their strengths and values.

    The following components must be on the individual treatment plan:

  • • Specific treatment needs identified in the diagnostic assessment to be addressed
  • • Measureable treatment goals and objectives, including baselines and expected changes from baselines
  • • Strategies for meeting the goals and objectives
  • • Specific staff responsible for implementing and monitoring each goal and objective
  • • Type, frequency and duration of the services that will be provided under the ITP, including need for provider travel or add-ons such as interactive complexity. If psychotherapy is not going to be provided in the next 90 days, the plan should explain why
  • • Cultural considerations and how they will impact the service plan and service delivery
  • • Client and family participation, including time spent with the family to develop the ITP and the documentation of any family concerns related to ITP implementation
  • • Signatures of the mental health professional and the parent or guardian or other adult authorized by law to provide consent for treatment
  • • Signatures must be dated
  • • A client’s parent or guardian may approve the ITP by secure electronic signature or by documented oral approval that is later verified by written signature
  • • In instances where oral approval is verified by a later written signature, the effective date is the date of oral approval, which is documented in the ITP
  • The following components must be present in the individual treatment plan review, whether appended to the ITP or as a separate document:

  • • Additional treatment needs that have been identified after the implementation of the ITP. This may be related to changes in the client’s situation or the result of newly discovered information
  • • Progress made on each existing ITP goal and objective, documented by changes in the measures established for the objectives, such as changes in the baselines for targeted behaviors, or increases in the use of trained skills. If objectives have not been achieved or related services have not been implemented, reasons should be identified
  • • Revised and new measureable treatment goals and objectives, including baselines and expected changes that providing the services will achieve in the baselines. Strategies for meeting the goals and objectives should be identified
  • • Type, frequency and duration of services to be provided under the revised ITP. If psychotherapy is not going to be provided in the next 90 days, the ITP should explain why
  • • Client and family participation, including time spent with the family to develop the ITP and documentation of any family concerns related to ITP implementation
  • • Signatures of the mental health professional and the parent or guardian or other person authorized by law to provide consent for treatment
  • • Signatures must be dated
  • • A client’s parent or guardian may approve the revised ITP by secure electronic signature or by documented oral approval that is later verified by written signature
  • • In instances where oral approval is verified by a later written signature, the effective date is the date of oral approval. The date of the oral approval must be verified by a later signature of the plan by the parent or guardian
  • Provide a copy of the approved ITP or ITP review to the parent or guardian and the youth, if the youth is legally able to consent for his or her own mental health treatment.

    Administering and reporting standardized measures
    CTSS providers are expected to administer (and bill separately for) standardized functional outcome measures and report resulting individual data as part of functional assessment and outcome evaluation. Instruments currently approved by the Commissioner of Human Services are:

  • • The Child and Adolescent Service Intensity Instrument (CASII) for persons six years old until 21 years old
  • • The Early Childhood Service Intensity Instrument (ECSII) for children five years old or younger
  • • The Strengths and Difficulties Questionnaire (SDQ) for all CTSS clients
  • • The Child Behavior Checklist (CBCL) for children five years old or younger when receiving CTSS from an agency with a DHS Early Childhood Mental Health Grant
  • These instruments may be replaced over time, as determined by the Commissioner.

    Document in progress notes the activities associated with administering and reporting of these instruments to the Department of Human Services, including time associated with data entry into MN-ITS, in accordance with Minnesota Statutes §9505.2175. The documentation must include date of the service, start and stop time of the activity, date of entry into the record and signature of the person writing the note, including title and credentials. Such activities do not include time spent in writing reports or interpreting the results for families or other providers.

    Timeframes
    Service plan development services are the only CTSS covered services that may be billed prior to the approval and signature of the ITP. Complete a standard or extended diagnostic assessment before claiming any CTSS covered services.

    Children’s Day Treatment

    Refer to Children’s Day Treatment for additional information about this service.

    Excluded Services

    The following services are excluded:

  • • Service components of CTSS simultaneously provided by more than one provider entity unless prior authorization is obtained
  • • Treatment by multiple providers within the same agency at the same clock time
  • • Children's therapeutic services and supports provided in violation of Medical Assistance policy in Minnesota Rules, part 9505.0220
  • • Mental health behavioral aide services provided by a personal care assistant who is not qualified as a mental health behavioral aide and employed by a certified CTSS provider entity
  • • Service components of CTSS that are the responsibility of a residential or program license holder including foster care providers under the terms of a service agreement or administrative rules governing licensure
  • • Consultation with other providers or service agency staff about the care or progress of a child
  • • Adjunctive activities that may be offered by a provider entity but are not otherwise covered by Medical Assistance, including:
  • • A service that is primarily recreation oriented or that is provided in a setting that is not medically supervised. This includes sports activities, exercise groups, activities such as craft hours, leisure time, social hours, meal or snack time, trips to community activities, and tours
  • • A social or educational service that does not have or cannot reasonably be expected to have a therapeutic outcome related to the client's emotional disturbance
  • • Prevention or education programs provided to the community
  • • Treatment for clients with primary diagnoses of alcohol or other drug abuse
  • Criteria for Concurrent Care in Partial Hospitalization and Other Group Settings

    Up to 15 hours of CTSS may also be provided when the service components of CTSS are identified in the discharge plan and are provided within a six-month time period if the child participates in a partial hospitalization program or resides in one of the following:

  • • Hospital
  • • Group home
  • • Residential treatment facility or regional treatment center
  • • Other institutional group setting
  • Authorization

    Refer to Authorization for general authorization policy and procedures. For CTSS services authorization is required to exceed:

  • • 200 cumulative hours per calendar year for any combination of:
  • • Psychotherapy (with patient or family member or both)
  • • Skills training
  • • Crisis assistance
  • • Mental health behavioral aide (MHBA) services
  • • 52 cumulative sessions per calendar year of group psychotherapy, including outpatient group psychotherapy services
  • • 26 cumulative sessions per calendar year of family psychotherapy, including outpatient family psychotherapy services
  • • 10 cumulative sessions per calendar year of multiple family group psychotherapy
  • Children’s day treatment hours are not included in the 200 hour threshold. Refer to Children’s Day Treatment for additional authorization criteria.

    When requesting authorization for services that are to be performed with interactive complexity, include the interactive complexity add-on code on the authorization request.

    Billing

    Follow these billing guidelines:

  • • Bill CTSS services using MN–ITS 837P
  • • Follow NCCI standards
  • • No interval is required between sessions
  • • Enter the treating provider NPI number on each claim line
  • • County contracted mental health rehabilitation providers must contact MHCP to verify that their profile allows for billing services outside the CTSS benefit package
  • Use the following table for billing services:

    Children’s Therapeutic Services and Supports (CTSS) for Children under 21 years old

    Proc Code

    Modifier

    Brief Description

    Unit
    (*Per CPT Time Rule)

    Service Limitation

    90832

    UA

    Psychotherapy (with patient or family member or both)

    30 (16-37*) min

    Interactive complexity add-on code (90785) may be used with:

  • • Psychotherapy (90832, 90834 or 90837)
  • • E/M with psychotherapy add-on codes (90833, 90836, 90838)
  • Use the UA modifier on interactive complexity add-on codes when reporting with CTSS services.

    E/M with psychotherapy add-on limited to:

  • • Clinical nurse specialist-mental health (CNS-MH)
  • • Psychiatric nurse practitioner (NP)
  • • Psychiatrist
  • Calendar year threshold, see Authorization - Psychotherapy (with patient or family member or both) counts toward the 200 hour CTSS authorization threshold (includes biofeedback and E/M with psychotherapy add-on).

    90834

    UA

    Psychotherapy (with patient or family member or both)

    45 (38-52*) min

    90837

    UA

    Psychotherapy (with patient or family member or both)

    60 (53+*) min

    Appropriate E/M and 90833

    UA

    E/M with psychotherapy add-on (with patient or family member or both)

    30 (16-37*) min

    Appropriate E/M and 90836

    UA

    E/M with psychotherapy add-on (with patient or family member or both)

    45 (38-52*) min

    Appropriate E/M and 90838

    UA

    E/M with psychotherapy add-on (with patient or family member or both)

    60 (53+*) min

    90875

    UA

    Individual psychophysiological therapy incorporating biofeedback, with psychotherapy

    30 (16-37)

    90876

    UA

    Individual psychophysiological therapy incorporating biofeedback, with psychotherapy

    45 (38-52) min

    90846

    UA

    Family psychotherapy without patient present

    1 session

    Calendar year thresholds, see Authorization:

  • • 26 sessions of family psychotherapy (including outpatient family psychotherapy)
  • • 10 sessions of multiple family group psychotherapy
  • 90847

    UA

    Family psychotherapy with patient present

    1 session

    90849

    UA

    Multiple family group psychotherapy

    1 session

    90853

    UA

    Group psychotherapy

    1 session

    Interactive complexity add-on code (90785) may be used with 90853.

    Calendar year threshold, see Authorization - 52 sessions of group psychotherapy (including outpatient group psychotherapy).

    90839

    UA

    Psychotherapy for crisis

    60 (53+*) min.

    CNS-MH; LICSW; LMFT; LPCC; LP; NP; psychiatrist; clinical trainee.
    Does not count toward the 200-hour CTSS authorization threshold.

    90840
    (add on to 90839)

    UA

    Psychotherapy for crisis, clinical trainee

    30 (16-37) min.

    CNS-MH; LICSW; LMFT; LPCC; LP; NP; psychiatrist.
    Does not count toward the 200-hour CTSS authorization threshold.

    H0031

    UA UD

    Administering and reporting standardized measures

    15 min

    Calendar year threshold, see Authorization - Administering and Reporting Standardized Measures services count toward the 200 hour CTSS authorization threshold.

    H0032

    UA UD

    Treatment plan development and review

    15 min

    Calendar year threshold, see Authorization – Treatment Plan Development and Review services count toward the 200 hour CTSS authorization threshold.

    H2014

    UA

    Skills training & development - individual

    15 min

    Only one type of skills training delivered to a recipient during the same clock time will be reimbursed.

    Calendar year threshold, see Authorization - Skills Training & Development counts toward the 200 hour CTSS authorization threshold.

    UA HQ

    Skills training & development - group

    UA HR

    Skills training & development - family

    H2015

    UA

    Comp community support services – crisis assistance

    15 min

    Calendar year threshold, see Authorization - Crisis Assistance counts toward the 200 hour CTSS authorization threshold.

    H2012

    UA

    Behavioral health day treatment – therapeutic components of preschool program

    60 min

    H2019

    UA

    Therapeutic behavioral services – Level I MHBA

    15 min

    Level I and Level II MHBA services cannot be delivered at same clock time.

    Calendar year threshold, see Authorization - Mental Health Behavioral Aide (MHBA) services count toward the 200 hour CTSS authorization threshold.

    UA HM

    Therapeutic behavioral services – Level II MHBA

    UA HE

    Therapeutic behavioral services – direction of MHBA


    Legal Reference

    MN Statutes 256B.0943 CTSS
    MN Rules 9505.0370, 9505.0371 and 9505.0372 definitions of clinical supervision, mental health professionals, diagnostic assessment

    MN Rules 9505.2175 case documentation

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