MHCP Provider Manual

Latest Manual Revisions

Revised: March 25, 2026

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.

March 25, 2026

Enrollment with MHCP

· Recuperative Care Enrollment Criteria and Forms – Under How to Enroll, we added information about submitting Recuperative Care Habitability Inspection Form (DHS-8846) and providing a list of documents required by the city and county with documentation that each requirement is met.

March 12, 2026

Dental Services

· Dental Authorization Requirement Tables

· Under Overview, we added what information should be included in the dental record.

· We added a new Diagnostic section.

· Under Restorative, Endodontics, Periodontics, Prosthodontics, Maxillofacial Prosthetics, Implant Services, Oral and Maxillofacial Surgery, Orthodontics and Adjunctive General Services, we updated information on what documentation should be submitted with authorization requests. Note, the services which require prior authorization have not changed.

· We updated language for clarity.

Equipment and Supplies

· Mobility Devices

· Under Noncovered Services, we added lever-activated wheel drive accessories. These accessories were already noncovered by MHCP under HCPCS code E0988.

· Under Replacement Components, we added HCPCS codes E2224, E2389, K0070. These replacement items were already covered by MHCP. We clarified that replacement components are purchase-only items, with the exception of power wheelchair accessories defined by HCPCS codes E2374 through E2378 and K0070. These power wheelchair accessories may be purchased or capped rentals.

· Under Billing, we added information for modifiers NU, KH, KI, KJ, and RR. Use modifier NU for purchases, RR for rentals, and KH, KI, KJ, and RR as appropriate for capped rentals.

· Respiratory Equipment

· Under Covered Services, we added items already covered by MHCP to the list of covered items. We added existing criteria from the Medical Supply Coverage Guide for respiratory suction pumps (E0600), closed system tracheal catheters (A4605), peak expiratory flow rate meters (A4614), breathing circuits (A4618), face tents (A4619), and variable concentration masks (A4620).

· Under Noncovered Services, we added batteries (A4611), cables (A4612), and chargers (A4613). These items are noncovered by MHCP as they are replacements for member-owned ventilators. MHCP covers ventilators as rental-only items. These supplies are included in payment for the service.

· Under Billing, we added information for modifiers NU, KH, KI, KJ, and RR. Use modifier NU for purchases, RR for rentals, and KH, KI, KJ, and RR as appropriate for capped rentals.

HCBS Waiver Services

· HCBS Waiver and AC Training Requirements – Effective June 1, 2026, there will be no exemptions to Home and Community-Based Services Waiver and Alternative Care training requirements for newly enrolled providers.

March 11, 2026

Equipment and Supplies

· Positive Airway Pressure for Treatment of Obstructive Sleep Apnea

· Under Covered Services, we expanded the list of covered services to include replacement parts. These items were already covered by MHCP.

· Under Billing, we added information for modifiers NU, KH, KI, KJ, and RR. Use modifier NU for purchases, RR for rentals, and KH, KI, KJ, and RR as appropriate for capped rentals. We clarified BiPAPs and CPAPs are capped rental only items , unless with an approved authorization for third party liability (TPL) that requires purchase rather than rental. Supplies for PAP devices are purchase only items.

March 10, 2026

Enrollment with MHCP

· Optical Company Enrollment Criteria and Forms – Optical companies are now required to employ at least one enrolled optometrist instead of the previous requirement of two.

March 9, 2026

Dental Services

· Dental Benefits

· Under Overview, we clarified the definition for calendar year.

· Under Clinical Oral Evaluations, we clarified service limits for CDT Codes D0120 and D0150.

· Under Diagnostic Imaging we clarified service limits for CDT Code D0210, D0270-0274 and D0373.

· Under Restorative, under Implant Services, we clarified service limits for CDT Code D2710-2722.

· Under Implant Services, we added CDT Code D6049 and D6280.

· Under Adjunctive General Services, we clarified service limits for CDT Codes D9222-D9247.

Equipment and Supplies

· Breast Pumps – Under Billing, we added information for modifiers NU, KH, KI, KJ, and RR. Use modifier NU for purchases, RR for rentals, and KH, KI, KJ, and RR as appropriate for capped rentals.

· Incontinence Products

· Under Covered Services, we listed out covered products and created a quantity limit table.

· Under Noncovered Services, we added HCPCS codes T4536 to T4540 as they are reusable products. MHCP does not cover reusable products. HCPCS code T4538 was previously covered by MHCP, but is no longer covered.

· Under Billing, we added modifier NU. Use modifier NU for purchases.

· Transcutaneous Electrical Nerve Stimulator (TENS)

· Under Covered Services, we clarified that Transcutaneous Electrical Nerve Stimulators (TENS) devices for treatment of acute pain during post-operative periods following surgery are covered as two month rentals. Rental periods must be supervised by physician to determine device effectiveness. If medical necessity persists, then the rental may continue. TENS devices become the member's property when the purchase price is met.

· Under Billing, we added documentation requirements. Documentation must include member diagnosis, order, areas of body experiencing pain, description of pain intensity and type of pain, item to be dispensed, anticipation duration of need, and requested medical necessity and policy information. We added information for modifiers NU, KH, KI, KJ, and RR. Use modifier NU for purchases, RR for rentals, and KH, KI, KJ, and RR as appropriate for capped rentals.

March 5, 2026

Equipment and Supplies

· Nebulizers

· Under Covered Services, we added compressors and supplies for nebulizers which were already covered by MHCP to the list of covered equipment. We input existing criteria from the Medical Supply Coverage Guide.

· Under Billing, we added information for modifiers NU, KH, KI, KJ, and RR. Use modifier NU for purchases, RR for rentals, and KH, KI, KJ, and RR as appropriate for capped rentals. Supplies are purchase items only.

Individualized Education Program Services

· Individualized Education Program (IEP) Services

· We added a new Other resources section which includes a hyperlink to the IEP resources webpage.

· Under Basics for all IEP services, we added a hyperlink to Individualized Education Program (IEP) and Individualized Family Service Plan (IFSP) Health-Related Services Procedure Codes.

March 4, 2026

Equipment and Supplies

· Ambulatory Assist Equipment

· Under Covered Services, we listed replacement parts for canes, crutches, and walkers. These parts were already covered by MHCP. Documentation must show the original item no longer functions. We also clarified that HCPCS codes A4635 to A4637 are not separately reimbursable within the same month of dispensing of ambulatory assist equipment. Replacement parts are purchase items only.

· Under Billing, we added information for modifiers NU, KH, KI, KJ, and RR. Use modifier NU for purchases, RR for rentals, and KH, KI, KJ, and RR as appropriate for capped rentals.

· Apnea Monitors

· Under Billing, we added information for modifiers NU, KH, KI, KJ, and RR. Use modifier NU for purchases, RR for rentals, and KH, KI, KJ, and RR as appropriate for capped rentals.

· Heat, Cold, and Light Therapy

· Under Billing, we added information for modifiers NU, KH, KI, KJ, and RR. Use modifier NU for purchases, RR for rentals, and KH, KI, KJ, and RR as appropriate for capped rentals. 

March 3, 2026

Equipment and Supplies

· Electrical Stimulation Devices

· Under Covered Services, we added Medicare guidelines for electrical stimulation devices for cancer treatment (E0766). This code previously required authorization. This change explains Medicare and MHCP's guidelines. Authorization is required every three months of treatment for continued use.

· Under Noncovered Services, we added previously noncovered HCPCS codes. We added examples of products that are categorized under these noncovered HCPCS codes by CMS' Pricing, Data Analysis and Coding (PDAC).

· Under Billing, we added information for modifiers NU, KH, KI, KJ, and RR. Use modifier NU for purchases, RR for rentals, and KH, KI, KJ, and RR as appropriate for capped rentals.

Provider Basics
Program and Services

· MHCP Benefits at-a-glance – As of January 1, 2026, major program XX does not cover home care services. We removed the X in the XX column for home care services.

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February 27, 2026

Provider Basics
Program and Services

· MHCP Benefits at-a-glance – Updated programs KK & LL age coverage.

February 23, 2026

Equipment and Supplies

· Apnea Monitors

· Under Eligible Providers, we revised the TPL and Medicare subsection.

· Under Covered Services, we listed out types of monitors and supplies covered by Minnesota Health Care Programs. MHCP covered these items previously, we have just updated this manual section to list them individually.

· Under Billing, we added information for billing and documentation requirements. Documentation must include member's diagnosis with risk factors, order, and the anticipated duration of need. Providers must use modifiers NU, RR, KH, KI, and KJ as appropriate for purchases and rentals.

· Breast Pumps

· Under the Eligible Providers heading, we added a TPL and Medicare subsection.

· Under Covered Services heading in the Breast Pump Supplies table, we updated the quantity limits for breast milk storage bags (A4287) and replacement valves for breast pumps (A4288).

· Under the Noncovered Services heading, we clarified baby weight scales and cleaning supplies for breast pumps are not covered.

February 20, 2026

Equipment and Supplies

· Ambulatory Assist Equipment

· Under Eligible Providers, we revised the TPL and Medicare subsection.

· Under Covered Services, we listed out the types of canes, crutches, walkers, and attachments covered by Minnesota Health Care Programs. MHCP covered these items previously, we have just updated this manual section to list them individually.

February 18, 2026

Provider Basics
Provider Requirements

· Provider Screening Requirements – We updated this page to include high-risk service providers and off-cycle revalidation.

February 17, 2026

Equipment and Supplies

· Orthotics and Prosthetics

· Under the Orthoses heading, we added a Supplies for Orthoses section. The section includes descriptions of supplies and replacement items covered by MHCP.

· Under the Repairs and Replacements heading, we added a Replacement Orthoses Components section. This section includes replacement HCPCS codes covered by MHCP.

· Under the Repairs and Replacements heading, we added information for labor and miscellaneous minor parts HCPCS codes L4205, L4210, L7510, and L7520.

Provider Basics

· Billing Policy Overview

· Under the Prompt Payment heading, we explained claims related to services that are at a high risk of fraud are considered complex claims.

· Under the Legal References heading, we corrected the statutory citation for the Prompt Payment section of the Billing Overview, from Minnesota Statutes, 62Q.75 to Minnesota Statutes, 16A.124.

February 6, 2026

Enroll with MHCP

· Housing Support Supplemental Services Enrollment Criteria and Forms

· Under the How to Enroll heading, we added that providers must submit a copy of all applicable Vendor Profile Forms provided by the lead agency (county or Tribe) to show eligibility for the supplemental service rate via MPSE or fax.

· Under the Add Housing Support Supplemental Services to an Existing Record heading, we added that if the request to add is made via fax, providers must fax a copy of all applicable Vendor Profile Forms provided by the lead agency (county or Tribe) to show eligibility for the supplemental service rate.

Housing Support Supplemental Services

· Housing Support Supplemental Services – Under Billing, we included Oct. 31, 2025, as the Housing Services Stabilization program end date.

February 4, 2026

Individualized Education Program Services

· We created a new manual titled Individualized Education Program (IEP) and Individualized Family Service Plan (IFSP) Health-Related Services Procedure Codes.

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January 29, 2026

Provider Basics
Provider Requirements

· Risk Levels and Enrollment Verification Requirements – We updated the risk levels for the 13 high-risk provider or service types.

January 27, 2026

Individualized Education Program Services

· Mental Health in Special Education (MH-SPED)

· We updated the page title to Mental Health in Special Education (MH-SPED).

· Under Covered Services, Dialectical Behavior Therapy and Child and Family Psychoeducation, we added information about documentation and provider qualification standards.

· Under Determination of Medical Necessity, Summary and Recommendations, we updated language to distinguish Mental Health in Special Education services from standard community mental health services. Policy updates included medical necessity and documentation; service specific mandates; changes in provider responsibility and progress note standards. Additionally, we added content about clinical trainees and practitioners and expanded treatment supervision requirements.

· We updated language for clarity.

January 26, 2026

Immunizations and Vaccinations

· Immunization and Vaccine Benefits Codes for Adults – Under Vaccines and Toxoids for Adults, we added CPT code 90620.

January 22, 2026

Equipment and Supplies

· Orthotics and Prosthetics

· Under the Lower Limb Prosthetics heading, we published new criteria for Osseointegrated External Prosthetic Connectors (HCPCS code L5991).

· Under the Repairs and Replacements heading, we added a Replacement orthoses and prostheses requirements chart. This chart lists requirements for various types of orthotic and prosthetic devices.

· Under the Authorization heading, we added HCPCS codes L8033, L8035, L8039, L8048, L8499, and V2629. These codes already required authorization always.

January 21, 2026

Child and Teen Checkups (C&TC)

· Child and Teen Checkups-Helpful Websites – We have removed this manual section from the MHCP Provider Manual. You can find links that were previously listed in this section of the provider manual in the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Program Services: Child and Teen Checkups (C&TC) section of the provider manual.

· Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Program Services: Child and Teen Checkups (C&TC)

· We added links under the following headings:

· Blood lead test

· Department of Human Services C&TC resources

· Minnesota Department of Health C&TC resources

· Other C&TC resources

January 13, 2026

Community First Services and Supports

· Community First Services and Supports (CFSS) – In the Service Authorization section, we updated the text to include monthly for the frequency providers must check member eligibility. We also updated the Documentation sections for CFSS provider agencies and FMS providers. We removed CFSS provider report from the CFSS provider agencies section and replaced it with MnCHOICES assessment information. We added the instruction to include receipts and invoices for all goods and services for FMS providers.

Early Intensive Developmental and Behavioral Intervention

· Early Intensive Developmental and Behavioral Intervention (EIDBI) billing grid

· We updated the billing grid language for CPT codes 97151 and T1024 to clarify eligible provider types.

· We updated to clarify 0373T is billed once per session based on the face-to-face time of a single provider, even when multiple providers are present, and must be delivered under the direction of a Level I or Qualified Supervising Professional provider on site.

· We explained midpoint billing rules require that units may only be billed if at least half of the unit time is provided. Daily limits indicate the maximum allowed to bill, but all services must be medically necessary.

· We updated 97155 to state the authorized amount should be about 20% of total intervention time (97153, 97154, 0373T), unless the Individual Treatment Plan specifies otherwise.

Personal Care Assistant Services

· Personal Care Assistant (PCA ) Services – We revised the Documentation Requirements section to remove the PCA assessment and service plan form DHS 3244 and replace it with form CFSS Assessment (DHS 6893A) (PDF).

January 12, 2026

Equipment and Supplies

· Nebulizers

· Under Eligible Providers, we added a TPL and Medicare subsection.

· Under Covered Services, we added a Nebulizer Supply Codes chart.

January 9, 2026

Individualized Education Program Services

· Covered and Noncovered Services IEP Health-Related Services – Under Initial Evaluations, Reevaluations and Health-Related Assessments, Covered Health-Related Components of an IEP Evaluation or Revaluation, we added information about indirect services including its definition, exception and billable and non-billable services.

Provider Basics

· Health Care Programs and Services – We added a new Cost of Care of Tuberculosis section. Under Overview, we added a hyperlink for the new section. Under Legal References, we added a hyperlink to Minnesota Statues, 144.4812.

January 8, 2026

Early Intensive Developmental and Behavioral Intervention

· Early Intensive Developmental and Behavioral Intervention (EIDBI) Benefit – Under the Service Authorization heading, we updated the medical review agent's authorization timeline under the Responsibilities, Request Additional Authorization of Services, and Transition and/or Discharge from an agency subheadings.

Reproductive Health/OB-GYN

· Abortion Services – Under Billing, we added information for billing MHCP directly for a member with Medicare as their primary insurance and does not qualify for an abortion under Medicare policy.

· Family Planning – Under Billing, we added criteria for billing CPT Code 58301 when billing for a member with Medicare as a primary insurer.

January 6, 2026

Rehabilitative Services

· Audiology Service s Procedure Codes – We removed CPT codes 92590-92595 as these are no longer covered effective Jan.1, 2026. We added audiology codes 92628, 92629, 92631, 92632, 92634-92639, 92641, and 92642 as covered effective Jan.1, 2026.

· Rehabilitative Service Codes for OT, PT and Speech-Language Pathology – We updated the Evaluative, Therapeutic and Rehabilitative table. We added CPT codes 98979, 98984 and 98985 as covered codes and updated the descriptions of CPT codes 98976 and 98977 effective Jan. 1, 2026.

January 5, 2026

Enrollment with MHCP

· Transportation Driver Enrollment Criteria and Forms

· We clarified the definition for a volunteer driver.

· Under How to Enroll, we clarified information for medical transportation organizations. Additionally, we added a new section for individual drivers.

Individualized Education Program (IEP) Services

· Personal Care Assistance (PCA) Services

· Under Eligible Members, we removed "Require assistance and be determined dependent in one activity of daily living or Level 1 behavior" from the criteria list.

· Under PCA Time Studies, we updated the procedure code to T1019.

· Under Billing, we added information to bill MA 1 unit using procedure code T1019.

January 2, 2026

Immunizations and Vaccinations

· Immunization and Vaccine Benefits Codes for Adults – Under Seasonal Respiratory Illness Vaccines, we added CPT code 90382.

January 1, 2026

Anesthesia Services

· Anesthesia Services – Under the Billing heading, we have added the 2026 Anesthesia Rates table and removed the 2024 Anesthesia Rates table.

Mental Health Services

· Psychological Testing

· Under the Billing heading, we increased the service hours limit from 8 hours to 10 hours

· We added an Authorization section explaining newly created authorization process and criteria.

· We added a Resources section listing CMS guidance for psychological testing services.

Reproductive Health/OB-GYN

· Breast and Cervical Cancer (BRCA) Genetic Mutation Testing

· We updated the page title to Breast and Cervical Cancer (BRCA) Genetic Mutation Testing.

· We removed content about presumptive eligibility (PE) because we added a new Presumptive Eligibility for Medical Assistance for Breast or Cervical Cancer Care page.

· Under Covered Services, BRCA Genetic Mutation Testing for Breast and Ovarian Cancer Susceptibility, we removed prior authorization requirements because they are no longer required beginning Jan. 1, 2026.

· We updated policy coverage language to reflect changes and for clarity.

· We added a new manual page for Presumptive Eligibility for Medical Assistance for Breast or Cervical Cancer Care.

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Previous Revisions

2025 Manual Revisions
2024 Manual Revisions
2023 Manual Revisions
2022 Manual Revisions
2021 Manual Revisions
2020 Manual Revisions
2019 Manual Revisions
2018 Manual Revisions
2017 Manual Revisions
2016 Manual Revisions
2015 Manual Revisions
2014 Manual Revisions
2013 Manual Revisions
2012 Manual Revisions
2011 Manual Revisions