Find in Table of Contents:

MHCP Provider Manual

2016 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.

12-30-2016
Addition(s)/Revisions

Transportation Services

· Local County or Tribal Agency Nonemergency Medical Transportation (NEMT) Services – Added recipients enrolled in the Minnesota Family Planning Program (MFPP) to eligible recipients; added information about reimbursement for MinnesotaCare members enrolled in a managed care plan on and after January 1, 2017, and an exception for MinnesotaCare enrollees with Medica.

· Nonemergency Medical Transportation (NEMT) Services (Overview) – Added recipients enrolled in the Minnesota Family Planning Program (MFPP) to eligible recipients; added information about reimbursement for MinnesotaCare members enrolled in a managed care plan on and after January 1, 2017, and an exception for MinnesotaCare enrollees with Medica.

· Protected Transportation Services – Added to the Eligible Recipient subsection that Medica health plan enrollees will receive protected transport services through fee-for-service from January 1, 2017, through April 30, 2017.

Programs and Services

· Emergency Medical Assistance (EMA) - Emergency Medical Assistance provides coverage for kidney transplant through an approved Emergency Medical Assistance Care Plan Certification Request. Prior authorization is required for the pre-kidney transplant evaluation. Inpatient Hospital Authorization is required for the kidney transplant. EMA kidney transplant coverage is outlined in Minn. Stat. §256B.06 Subd4 (j) (3). This benefit became effective, July 1, 2016.

· Kidney Transplant Services – Emergency Medical Assistance provides coverage for kidney transplant through an approved Emergency Medical Assistance Care Plan Certification Request. Prior authorization is required for the pre-kidney transplant evaluation. Inpatient Hospital Authorization is required for the kidney transplant. EMA kidney transplant coverage is outlined in Minn. Stat. §256B.06 Subd4 (j) (3). This benefit became effective, July 1, 2016.

Provider Basics

· Authorization – Emergency Medical Assistance provides coverage for kidney transplant through an approved Emergency Medical Assistance Care Plan Certification Request. Prior authorization is required for the pre-kidney transplant evaluation. Inpatient Hospital Authorization is required for the kidney transplant. EMA kidney transplant coverage is outlined in Minn. Stat. §256B.06 Subd4 (j) (3). This benefit became effective, July 1, 2016.

Reproductive Health

· Minnesota Family Planning Program (MFPP) – Updated the MFPP section to reflect changes effective January 1, 2017:

· MFPP no longer has an age requirement

· Presumptive eligibility begins on the day a provider approves eligibility and ends on the date the full MFPP determination is completed or the last day of the month following the month it was approved, whichever is earlier

· An applicant may request MFPP eligibility retroactively for up to three months before the month in which he or she completes the application

· MFPP covers nonemergency medical transportation services

12-29-2016
Addition(s)/Revisions

Dental Services

· Critical Access Dental Payment Program (CADPP)

· Under Eligible Providers, we deleted the level of service provided by the dentist is critical to maintaining adequate levels of patient access within the service area. This no longer applies.

· We updated the Reimbursement of Services section for the change effective January 1, 2017, in how critical access dental payments are calculated.

12-23-2016
Addition(s)/Revisions

Dental Services (Overview) – As of January 1, 2016, Teledentistry is a covered service and instructions on how to bill for these services have been added to the provider manual.

12-22-2016
Addition(s)/Revisions

Child and Teen Checkups (C&TC) – The C&TC CPT code will change for maternal depression screening effective January 1, 2017. The CPT code which is currently being used for maternal depression screening, as described in the Child and Teen Checkups (C&TC) policy, 99420 with a UC modifier, will be discontinued. The new CPT code for maternal depression screening will be 96161.

Community Emergency Medical Technician (CEMT) Services – We posted a new section for the new provider type of community emergency medical technician (CEMT).

12-19-2016
Addition(s)/Revisions

Laboratory/Pathology, Radiology & Diagnostic Services

· Laboratory and Pathology Services – Updated Outpatient Hospital Laboratory Tests in the Billing section to Medicare's packaging policy and pricing guidelines for 2016 & 2017. Added information for dates of service January 1 through December 31, 2016, and for dates of service on or after January 1, 2017.

12-14-2016
Addition(s)/Revisions

Transportation Services

· Nonemergency Medical Transportation (NEMT) Services (Overview) – Added information about NEMT transport services reimbursement in the Overview section; added information and examples about multiple riders in the Covered Services, Multiple Riders section. Updated definition of transportation coordinator to make it clear it is an administrative function only. Transportation coordinators cannot provide direct transportation services.

12-12-2016
Addition(s)/Revisions

Transportation Services

· Local County or Tribal Agency Nonemergency Medical Transportation (NEMT) Services Claim, Service, and Rate Information – Specified the service modifiers for A0100, S0215, and T2003 need to be origination and destination identifiers.

· Protected Transportation Services – Moved the level of service information from the Eligible Recipients section to the Overview section at the beginning. Clarified that for medical personnel at the medical facility making the LOS determination for protected transport, the recipient must be stabilized and the transport less than 100 miles.

11-22-2016
Addition(s)/Revisions

Early Intensive Developmental and Behavioral Intervention (EIDBI) – Clarified billing and authorization procedures for providers.

11-17-2016
Addition(s)/Revisions

Day Training and Habilitation (DT&H) Day Services – Removed language under Lead Agency Responsibilities regarding the Children and Community Services Act (CSSA) since this is no longer in effect. Removed language under Submitting Claims about datespan billing. Each date must be billed on a separate line.

Hospital Services

· Inpatient Hospital Services – Clarified billing guidance for inpatient hospital stays where the recipient transitions between fee-for-service (FFS) and managed care during the inpatient stay.

Provider Basics

· Billing Policy Overview – Under General Billing Requirements, exception added for EW/AC Environmental Accessibility Adaptations (EAA) for billing for date of service.

11-16-2016
Addition(s)/Revisions

Dental Services

· American Dental Association (ADA) Request for Authorization Claim Form Instructions – Corrected instruction for entering ICD-9 – use only ICD-10 diagnosis code qualifier.

Clinic Services

· Federally Qualified Health Center and Rural Health Clinics – We added "Low Level Services Provided by Mid to High Level Practitioner" under Eligible Providers.

11-14-2016
Addition(s)/Revisions

HCBS Waiver Services

· Billing for Waiver and Alternative Care (AC) Program – Updated language under Submitting Claims to only bill with date span for monthly code; otherwise each date must be billed on a separate line.

11-09-2016
Addition(s)/Revisions

Equipment and Supplies – Policy clarifications related to respiratory equipment including added policy for upgrades and add-ons. Removed information that is repeated in the Medical Equipment Coverage Guide.

· Positive Airway Pressure – Clarified authorization and documentation requirements for CPAP and BiPAP.

· Respiratory Equipment – Expanded and changed coverage policy for ventilators, CPAP and BiPAP devices.

Laboratory/Pathology, Radiology & Diagnostic Services

· Laboratory and Pathology Services – Required drug screening for employment related issues and when court ordered are not medically necessary and are not covered. For services other than Medication Assisted Therapy, drug testing costs are not included in the CCDTF rate.

Effective for dates of service on and after October 1, 2016, drug screening is considered medically indicated, as described in Medicare Local Coverage Determination L36037. Report drug screening using G0477 or G0481 per encounter.

11-03-2016
Addition(s)/Revisions

Early Intensive Developmental and Behavioral Intervention (EIDBI)

· Early Intensive Developmental and Behavioral Intervention (EIDBI) Benefit Billing Grid – EIDBI Billing Grid was revised to provide clarification of professional and education level for all procedures, increasing the parameter for CMDE service and initial ITP, specifying the limits for EIDBI individual and group intervention, clarification and detail for the service limits and under the additional notes for all EIDBI procedures on the billing grid, and listing out the abbreviation and definition of the provider type for each modifier on the last page under the key.

Early Intensive Developmental and Behavioral Intervention (EIDBI)

· Early Intensive Developmental and Behavioral Intervention (EIDBI) Provider Enrollment –Removed language instructing providers to complete and submit assurance statements for all levels of service they will provide. Added enrollment requirements and documents for telemedicine services.

10-25-2016
Addition(s)/Revisions

Alcohol and Drug Abuse Services

· Continuum of Care Pilot – We updated the following:

· Clinical Eligibility under the CCDTF Eligibility section to note that while the three new pilot services do not have to fall within the severity rating required for formal treatment services, they still require at least a severity rating of 1 in at least one of the six dimensions.

· Noncovered Services to clarify that more than one assessment within a six month span is not covered for the duration of the Pilot and that assessment updates are to be billed as Care Coordination encounters.

· Billing section to clarify to bill COC pilot services and primary treatment services on separate claims.

Mental Health Services

· Children’s Therapeutic Services and Supports (CTSS)

· CTSS program Overview section expanded to include clarification on the definition of Children's Therapeutic Services and Supports and program expectations.

· Updated Eligible Providers section for language clarification and to include school-based providers.

· Updated Mental Health Professional section to include Tribally approved Mental Health Professionals.

· Updated CTSS Certification section to add treatment plan development and functional assessment as a core service as well as day treatment or mental health behavioral services that can be added later to the certification.

· Added a Decertification section.

· Updated Eligible Recipients section to clarify age as well as the defining language for diagnoses that need to be included on the diagnostic assessment.

· Expanded Psychotherapy section under Covered Services to better define the purpose.

· Added clinical trainee under skills training section.

· Added clinical supervision requirements under Skills Training section.

· Added "Actions the family should be prepared to take to resolve or stabilize a crisis" to Crisis Assistance section.

· Added MHBA clinical supervision under MHBA section.

· Added clinical trainee next mental health professional when referenced in the Services section.

· Added a Service Plan Development section.

· Updated Excluded Services Section.

· Updated billing grid to include procedure codes for psychotherapy for crisis, clinical trainee, treatment plan development and review, and administering and reporting standardized measures.

Updated Legal References to reflect new legislation.

10-24-2016
Addition(s)/Revisions

Immunizations & Vaccinations – Added new 2016-2017 influenza season vaccine code 90674 for children and code 90653 for adults.

10-21-2016
Addition(s)/Revisions

Provider Basics
Billing Policy
Billing the Recipient

· Minnesota-defined U Modifiers - We made the following changes is this section:

U1:

Deleted:

· Access Transportation Services

· Incontinence supplies

· Personal care assistant provider with familial relationship to recipient

· Revised from transportation mileage to Nonemergency Medical Transportation (NEMT) – unassisted transportation mileage

· Deleted incontinence supplies

Added:

· Basic living and social skills for community living and community living by a mental health rehabilitation worker

· Home and Community-based supports

· Health care home

Deleted:

· Consumer directed community supports

Added:

· Consumer Directed Community Support

· Health Care Home

Deleted:

· Nonemergency Medical Transportation (NEMT taxi or equal, door-to-door

· Certified peer specialist

Added:

· Certified peer specialist – advanced level

Deleted:

· Nonemergency Medical Transportation (NEMT) taxi or equal, wheelchair, curb-to-curb

· End tidal CO2 spot check, weekly rental

Clarified:

· Individualized Education Program (IEP) personal care assistance

Added:

· End tidal CO2 spot check, weekly rental

Deleted

· Nonemergency Medical Transportation (NEMT taxi or equal, door-to-door

· Adult Day care – Essential Community Support (ECS)

Deleted:

· Access Transportation, bus/light rail monthly pass

· Mental health clinical care consult

Added:

· Adult Day Care – Essential Community Support (ECS)

Revised:

· Mental health clinical care consult

Deleted:

· Community First Services and Supports (CFSS)

Added:

· Housing Access Services, person centered planning

· Mental health clinical care consult

· Teledentistry

Deleted:

· Housing Access Services, stage 1

· Nonemergency medical transportation – broker review

· Mental health clinical care consult

Added:

· Nonemergency medical transportation (NEMT), protected transport

Revised:

· Mental health clinical care consult

Deleted:

· Nonemergency medical transportation (NEMT), taxi or equal, wheelchair, assisted station-to-station

Added:

· Mental health clinical care consult, 31 or more minutes, unlisted psychiatric service or procedure

Deleted:

· Mental health assessment by nonphysician (ARMHS)

Added:

· Mental health assessment by nonphysician (ARMHS)

· Housing Access Services (HAS); Stage 3, (non PMAP)

10-19-2016
Addition(s)/Revisions

Provider Requirements

· Provider Screening Requirements – Medicare considers Indian Health Services and Pharmacies institutional providers. We need to collect a screening fee from these providers and added them to the List of Medicare Institutional Providers in this section.

10-13-2016
Addition(s)/Revisions

Provider Requirements

· Risk Levels and Enrollment Verification Requirements – Updated for the following:

· Rehabilitation Agency – added enrollment fee required, if CORF (Comprehensive Outpatient Rehabilitation Facilities)

· Day Training & Habilitation – added enrollment fee is required

· Indian Health Services – enrollment fee required for all; deleted that enrollment fee is required only if CTSS or ARMHS

· Home Health Agency – updated Risk Level – added moderate for existing providers at revalidation

· Pharmacy – added clarification "IF DME COS = 032, 116 & 076"; updated Risk Level, changed enrollment fee required from "if DME" to all

· Transportation Broker – Added with risk level "limited"

· Medical Supply – updated risk level

Transportation Services

· Local County or Tribal Agency Nonemergency Medical Transportation (NEMT) Services – Updated personal mileage reimbursement rate information for dates-of-service on/before 6-30-2016 and the rate adjustment for dates-of-service on/after 7-1-2016.

· Protected Transportation Services – Changed the rules for an attendant for a protected transport.

10-12-2016
Addition(s)/Revisions

Dental Services

· American Dental Association (ADA) Request for Authorization Claim Form Instructions – Moved the paper prior authorization instructions from the provider home page to the MHCP Provider Manual. Updated language to reflect current state review agent.

10-03-2016
Addition(s)/Revisions

Behavioral Health Homes Services – The new Behavioral Health Homes Services manual page has been added.

09-30-2016
Addition(s)/Revisions

Hospice Services – Reorganized and clarified information throughout this section and added, clarified, or deleted information in the following sections:

· Eligible Providers: Added that a nurse practitioner may not serve as the medical director or as the physician member of the hospice interdisciplinary group.

· Eligible Member: Added that a member must have filed an election statement with the selected hospice and if dual eligible, with both Medicare and Medicaid. Added new subsections for information about Hospice Eligibility and Noncovered Services When in Hospice.

· Election of Hospice: Deleted the detailed instructions for the Hospice Transaction form since that information is on the form the hospice must complete.

· Covered Services: Added clarifying statement that bereavement counseling does not qualify for additional payment.

· Services Provided Outside the Hospice Benefit: Added information about concurrent care for children from birth to age 21. For Physicians Services and Medical Supplies and Equipment, added diagnosis codes and documentation requirements

· Hospice Payments and Limits: Added revenue codes for routine home care and service intensity add-on (SIA)

· Billing: Clarified and added text and organized it into four subsections for Coordination of Benefits, Hospice Care-Medical Services, Fee-for-Service Room and Board, and Hospice Physician Services.

· Definitions: Added definition for Core Based Statistical Area (CBSA) Rate

09-23-2016
Addition(s)/Revisions

Mental Health Services

· General MHCP Non-Enrollable Mental Health Provider Requirements – Added clarification that adult day treatment providers are required to follow Clinical Supervision of Outpatient Mental Health Services (Rule 47) guidelines.

09-22-2016
Addition(s)/Revisions

Provider Basics

· Authorization – Corrected mailing address for KEPRO.

09-21-2016
Addition(s)/Revisions

Transportation Services

· State-Administered Transportation Procedure Codes, Modifiers and Payment Rates – For Protected Transport (Mode 6), changed Procedure Code T2003 modifier from U8 to UA and added modifier UA to Procedure Code S0215.

09-20-2016
Addition(s)/Revisions

Mental Health Services

· Mental Health Provider Travel Time – Clarified mental health provider travel time variations under Overview section.

· Mental Health Medication Management – Added Overview section defining Medication Management. Information added to Billing section to clarify E/M code usage.

09-19-2016
Addition(s)/Revisions

Mental Health Services

· Intensive Residential Treatment Services (IRTS) – The following information has been revised:

· IRTS treatment team member qualifications updated to reflect MN Statutes 256B.0622, Subd 2, (e).

· Billing table eligibility for concurrent services Service Limitation field updated for ACT, ARMHS, Outpatient Psychotherapy, Waivered Services and other medical services.

· Physician Consultation, Evaluation and Management – Added text under Eligible Providers and Eligible Recipients.

09-15-2016
Addition(s)/Revisions

Transportation Services

· Protected Transportation Services – Added a link to the Protected Level of Service Assessment (DHS-6715) (PDF).

09-14-2016
Addition(s)/Revisions

Equipment and Supplies

· Transcutaneous Electrical Nerve Stimulator (TENS) – Updated Eligible Providers section to clarify prescribing providers and dispensing providers.

09-09-2016
Addition(s)/Revisions

Equipment and Supplies

· Incontinence Products – Updated quantity limit tables and removed obsolete references and tables related to performance levels. Added clarifying information under Coverage Criteria and Authorization.

09-02-2016
Addition(s)/Revisions

Group Residential Housing (GRH) Supplemental Services – New section for MHCP Provider Manual has been added for Group Residential Housing (GRH) supplemental services. Effective date of change January 1, 2017.

08-29-2016
Addition(s)/Revisions

Transportation Services

· Local County or Tribal Agency Nonemergency Medical Transportation (NEMT) Services Claim, Service, and Rate Information – Under Modifiers Required, added Mode 4 to read "Mode 4 – Assisted Transport". For Bus, Paratransit and Air Travel, clarified that rural urban commuting area (RUCA) does not apply.

08-25-2016
Addition(s)/Revisions

Transportation Services

· State-Administered Transportation Procedure Codes, Modifiers and Payment Rates – Updated rates and updated descriptions to match the July 1, 2016, changes. Moved assisted transportation (Mode 4) information to the Local county or tribal agency codes and rates page.

08-24-2016
Addition(s)/Revisions

Child and Teen Checkups (C&TC) - Added a new subsection about CPT codes for billing vision screening claims. When you use both 99173 and one of the preventive visit CPT codes in the range of 99381–99397, you need to add a modifier to 99173 on the original claim. You also need to add a modifier to 99173 if you have any denied claims for this code pair.

Early Intensive Developmental and Behavioral Intervention (EIDBI)

· Early Intensive Developmental and Behavioral Intervention (EIDBI) Provider Enrollment – Correction to form number for EIDBI Assurance Statement for Qualified Supervising Professionals from 1720C to 7120C under the requirements of EIDBI Provider Agencies.

08-18-2016
Addition(s)/Revisions

Early Intensive Developmental and Behavioral Intervention (EIDBI)

· Early Intensive Developmental and Behavioral Intervention (EIDBI) Benefit – Added increase of hours or units under service limits on the EIDIBI Billing Grid for the following sections: Individual Treatment Plan ITP Development and Monitoring, Family/ Caregiver Training and Counseling Individual, Family/ Caregiver Training and Counseling Individual-Telemedicine, and Family/ Caregiver Training and Counseling Group.

08-17-2016
Addition(s)/Revisions

Mental Health Services

MHCP Professional Certification & Enrollment Requirements – The following revisions have been added to the MHCP Professional Certification & Enrollment Requirement stable:

· Neuropsychology: MN licensure requirements corrected to reflect new Statute MS 9505.0372.Subp.2

· Licensed Independent Clinical Social Worker (LICSW): Licensure requirements updated to reflect new statute MS 148E.055, 148E.010, 148E.100 and 148E. 125.

· Psychiatrist: Certification requirements have been updated to add Osteopathic Physician licensure requirements.

· Clinical Nurse Specialist: Licensure requirements corrected to reflect statute MS 148.171 to 148.285.

· Certified Mental Health Rehabilitative Professional: added statute 256B.0623 for Mental Health Rehabilitative Worker certification requirements.

08-15-2016
Addition(s)/Revisions

HCBS Waiver Services

· Home and Community Based Services (HCBS) Programs Provider Enrollment – Added reference to the Revalidation subsection of the Provider Screening Requirements Provider Manual section under HCBS Provider Enrollment Revalidation.

Pharmacy Services

· 340B Drug Pricing Program – This is a new section to clarify the requirements of the 340B drug pricing program.

Transportation Services

· Local County or Tribal Agency Nonemergency Medical Transportation (NEMT) Transportation Services

· Added Wright County to the list of counties now contracting with MNET.

· Added a note to clarify the local county or tribal agency responsibilities for assisted transport (Mode 4), and that providers in the MNET-contracted counties must be enrolled with MNET to receive reimbursement.

08-12-2016
Addition(s)/Revisions

Hospital Services

· Inpatient Hospital Authorization – Updated information in this section to provide clearer guidance on the readmissions and roles of providers. We made the following changes:

· Added a statement to clarify that providers may not seek payment from recipients for inpatient hospital services for which IHA is required, but not issued.

· Clarified in the Obtaining Inpatient Hospital Authorization section that "physician" refers to a medical review physician.

· Deleted subsection about version 2007 DRG information – this version no longer applies.

· Deleted subsection about DRG circumcision – this no longer applies.

· Clarified language in subsection Admissions Determined to be Not Medically Necessary

· Changed the Recertification subsection to Need for Care—Certification and Recertification and clarified requirements

· Added definitions for Authorization Number, Certification of Need for Care, Medical Review Physician, and Recertification

08-10-2016
Addition(s)/Revisions

Individualized Education Program (IEP) Services

· IEP Billing and Authorization Requirements – Removed the table that explained the IEP Procedure Code, Modifier and Units for dates of service prior to July 1, 2015. Removed the ICD-9 reference for diagnosis code 315.9 for dates of service prior to September30, 2016.

08-09-2016
Addition(s)/Revisions

Day Training and Habilitation (DT&H) Day Services – Changed developmental disability to disabilities under Eligible Providers and Noncovered Services.

08-05-2016
Addition(s)/Revisions

Hospital Services

· Inpatient Hospital Services

· We removed the subsection for Evidence-Based Childbirth Program, this program no longer exists.

· In the subsection for Incarceration we corrected the link so that it links correctly to the Outpatient Hospital Services Billing section.

· In the subsection MHCP Eligibility Beginning After the Date of Inpatient Admission, we removed the last bullet of the instructions for payment that said to include a letter to the DHS Claims Supervisor; this instruction no longer applies.

· Clarified the effective date for the subsection Inpatient Hospital Services when First Date of Eligibility is Discharge date, and added payment instructions.

Mental Health Services

· Diagnostic Assessment – Revisions to the manual include formatting changes, adding Table of Content, changed the order of the DAs listing to Standard, Extended, Adult and Brief. Also, Eligible Provider heading, provided a more comprehensive listing of eligible providers. Added information regarding necessary documentation components for covered services, Individual Treatment Plan, Progress notes and Clinical Supervision section has been added. Also, Noncovered Services section added. For Extended DA for children under 5, assessment evaluation criteria regrouped into the developmental, social, emotional functioning skills examples.

08-04-2016
Addition(s)/Revisions

HCBS Waiver Services

· Billing for Waiver and Alternative Care (AC) Program – Added two items: long term care insurance to payer determination and exception to datespan for billing procedure code H2015 with or without modifiers. Also, removed references to "month and monthly" in the Rates for Elderly Waiver (EW) section.

Mental Health Services – In the list of mental health professionals that may enroll in MHCP, we changed psychiatrist to psychiatry or an osteopathic physician.

08-03-2016
Addition(s)/Revisions

Rehabilitation Services – We removed references to Speech-Language Pathology Assistants; this information was added to this section in error.

07-26-2016
Addition(s)/Revisions

Provider Basics

Provider Requirements

· Clarified language in Enrollment Process for Providers Located in Minnesota

· Updated the Checking the Federal and State Exclusions Lists section to clarify provider requirements to check the lists and what information the lists show.

· Added in the Sale and Transfer portion of a Provider Entity section that MCHP may stop or withhold payments if a new entity's enrollment is not complete. MHCP must process and approve the new entity owner's enrollment before we can pay claims for services they provide.

07-19-2016
Addition(s)/Revisions

Equipment and Supplies

· Nutritional Products and Related Supplies – Updated Billing section under Pricing for enternal nutritional products to reflect changes made by 2016 legislation.

· Patient Lifts and Seat Lift Mechanisms – In the Billing section, deleted information about billing electric patient lifts with modifier U3 for higher reimbursement and replaced with new information that electric patient lifts will be priced by report effective July 1, 2015, due to 2016 legislative change.

Laboratory/Pathology, Radiology & Diagnostic Services

· Laboratory/Pathology Services – Exome and genome testing requirements will be reviewed on a case-by-case basis. You must include an attachment with the claim that explains the medical necessity and indicates how the results of the test will influence treatment. Claims will pend until each case is reviewed.

Mental Health Services

· Functional Assessments – The Vocation section has been updated to provide direction on completing the Functional Assessment including what should be considered in the decision making process. The section provides a description of purposeful activity, structured activities and questions that should be considered during the assessment.

07-18-2016
Addition(s)/Revisions

Reproductive Health/OB-GYN
Abortion Services

· Family Planning Codes with Increased Rates – Clarified the ICD-9 and ICD-10 diagnosis code ranges stated at the top of the section.

· MHCP ICD-9 to ICD-10 Abortion Diagnoses Conversion Table – Added Z33.2 as a covered ICD-10 diagnosis.

07-15-2016
Addition(s)/Revisions

Rehabilitation Services – Added speech-language pathology assistants to list of providers that can provide specialized maintenance therapy.

07-14-2016
Addition(s)/Revisions

Child Welfare Targeted Case Management (CW-TCM – Deleted information in the Overview about the 2007 interim federal rule. Reorganized and clarified some of the information in the Dual Case Management section.

07-13-2016
Addition(s)/Revisions

Clinic Services

Federally Qualified Health Center and Rural Health Clinics

· We made the following revisions in this section:

· Deleted a sentence that was not clear about services being paid differently for certain individuals. All information about payment methodology is later in the section.

· Clarified information in the Existing Clinics section about prospective payment and alternative payment methods.

· Instead of: Changed all references that read MAPM (Minnesota Alternative Payment Method), we've changed all to APM (Alternative Payment Method).

· Added information about payment rate methodology in a table to explain the differences between methodologies

· Clarified text in Rate Change Claim Adjustments section

· Removed references to MinnesotaCare with MA benefits; the MinnesotaCare type designated determines the benefits the person is eligible for

· Clarified MHCP covered services in the Covered Services section

· Added a new section with information about MCO enrollee claim submittal for services provided January 1, 2015, and after

· Added a new section for Maternity and Surgical Services

· Reorganized the information in the Provider Based RHC and Free-Standing RHC Billing MHCP Hospital Services section

07-08-2016
Addition(s)/Revisions

Physician and Professional Services

· Added information in the Outpatient Physician-Administered Drugs section explaining billing for injections that involve multiple national drug codes (NDCs).

· Added in the Reporting the Discarded Portion of Administered Drugs section to report unused and discarded drugs on a separate claim line using the JW modifier.

· In the Telemedicine section, we deleted the incorrect sentence that said prepaid health plans may choose whether to pay for telemedicine services.

· Under Hospital Physician Services, we deleted the outdated Evidence-Based Childbirth Program section.

· We added a new section under Medical Nutrition Therapy on the National Diabetes Prevention Program.

Reproductive Health/OB-GYN

· Family Planning Codes with Increased Rates – Added J7297 (Levongestrel IUD 52mg 3 year) & J7298 (Levongestrel IUD 52mg 5 year) codes to the Family Planning Codes with Increased Rates codes list. Both codes are effective January 1, 2016.

07-06-2016
Addition(s)/Revisions

Provider Basics
Provider Requirements

· Access Services – Clarified and updated covered transportation services:

· Added "and ancillary expenses" with transportation because this information is about the services ancillary to transportation

· Added links to relevant transportation sections for complete information about covered transportation services

· Deleted mileage and bus or taxi fare; these are covered under transportation

· Added "tolls" as an expense that is covered, along with parking expense

07-01-2016
Addition(s)/Revisions

HCBS Waiver Services – Added Crisis Respite to BI and CADI waivers.

Transportation Services

· Nonemergency Medical Transportation (NEMT) Services (Overview) – General clarifications made throughout the Transportation Overview section to reflect changes effective July 1, 2016.

· Access Services Ancillary to Transportation – This is a new section of the Provider Manual. This new section has information that was previously included in the Access Services section, particularly the information about travel expenses.

· Ancillary Services Claim and Rate Information for Counties and Tribes – This is a new page that details the billing process, procedure codes and modifiers added for Ancillary Access Services.

· Local County or Tribal Agency Nonemergency Medical Transportation (NEMT) Transportation Services – Changed the title of this section from Access Transportation Services to Local County or Tribal Agency Nonemergency Medical Transportation (NEMT) and made general clarifications throughout the section related to the July 1, 2016, NEMT changes.

· Local County or Tribal Agency Nonemergency Medical Transportation (NEMT) Services Claim, Service, and Rate Information:

· Clarifications made throughout this manual section, including changing the name to reflect July 1, 2016, NEMT changes.

· Changed terms used for procedure codes:

· Ambulatory A0100 is now unassisted transport with a base rate increase to $11

· Ambulatory S0215 is now unassisted transport with mileage rate increase to $1.30.

· Ambulatory T2003 is now assisted transport with base rate now $13

· Ambulatory S0215 is now assisted transport with mileage rate $1.30

· Added section for Modifiers Required

· Added section about Rural Urban Commuting Area Adjustments Add-ons

· Protected Transportation Services – This new Protected transportation section includes the information on this new mode of transportation that is effective July 1, 2016.

· State-Administered NEMT – We made general clarifications throughout and changed the name of this section from Special Transportation Services to State-Administered NEMT to reflect July 1, 2016, changes.

06-28-2016
Addition(s)/Revisions

Provider Basics
Programs and Services

· Emergency Medical Assistance – Added that effective for dates of service on and after July 1, 2016, EMA covers kidney transplants, including coverage criteria.

06-27-2016
Addition(s)/Revisions

Dental Services

· Critical Access Dental Payment Program (CADPP)

· Removed criteria requiring private practice dentists to be in a Health Professional Shortage Area (HPSA) designated location.

· Change for dentist offices located outside the seven-county metropolitan area from 50% or more to 25 percent or more of the dentist's patient encounters per year must be with patients who are uninsured or covered by Medical Assistance or MinnesotaCare.

06-23-2016
Addition(s)/Revisions

Provider Basics

· Authorization

· Added that KEPRO is now the review agent for Emergency Medical Assistance (EMA) Care Plan Certification (CPC) requests.

· Clarified information in the Review Agents section to emphasize which types of requests go to which review agents.

· Moved the information about requests that are submitted to MHCP to be listed before the other review agent information.

· Added bookmarks under the heading "How to submit authorization requests to KEPRO," that direct you to more information about each method for submitting requests.

· Clarified that Inpatient Hospital authorizations can be submitted through the KEPRO portal, by phone or U.S. mail.

06-16-2016
Addition(s)/Revisions

Reproductive Health

· Abortion Services – This section was revised. Do not split FFS-only claims. Only split claims that are FFS and MCO, per the instructions listed under Billing for Non-Abortion Related Services. To clarify this, the list of Non-Abortion Services was deleted and the first bullet under the Billing section, under Non-Abortion Related Services, was removed.

06-14-2016
Addition(s)/Revisions

Dental Services

· Children and Pregnant Women

· We deleted that the minimum age for a child to receive bitewing x-rays is 3 years of age.

· We added information about house calls for removable prosthesis. Effective July 1, 2016, MHCP will cover up to five house calls (D9410) each calendar year for fitting removable prosthesis. Bill both CPT codes D9410 and D5992; D9410 will pay at the current rate and D5992 will pay at zero.

Rehabilitative Services

· Added new policy criteria about speech-language pathology assistants and telemedicine

· Clarified information about therapists in private practice.

· Changed terminology from "rehabilitative" to "rehabilitation" throughout

· Clarified requirements for audiologists

Reproductive Health

· Obstetric Services and HIV Counseling – Added that MHCP will now cover ultrasounds for the Zika virus if a positive diagnosis is determined from a blood test.

06-13-2016
Addition(s)/Revisions

Reproductive Health

· Free-Standing Birth Center Services – Added that ultrasounds are now covered for a positive Zika virus diagnosis.

06-10-2016
Addition(s)/Revisions

Dental Services

· Non-Pregnant Adults

· Added procedure code D5992 under Prosthodontics. This is only billable with D9410. D9410 will pay at the current rate and D5992 will pay at zero.

· Added more information about Service Limits for procedure code D9410 under Adjunctive Services.

06-09-2016
Addition(s)/Revisions

Chiropractic Services – Clarified text about Acupuncture under Covered Services.

06-03-2016
Addition(s)/Revisions

Anesthesia Services – Deleted the third modifier table.

Clinic Services – Updated procedure code S9123 unit (hour) maximum to one unit per day.

05-31-2016
Addition(s)/Revisions

Clinic Services – Updated billable units for S9123 and rate change as follows:

· S9123 Nursing care, in the home or place of residence, by PHN or registered nurse (Unit = 1 hour, two units allowed per day)

· Added three codes in the Billing for PHNC services section:

· 99501 - Home Visit for Post-natal assessment and follow up care-Mother

· 99502 - Home visit for newborn care and assessment

· S9443 - Lactation classes, nonphysician provider, per session

Hospital Services

· Inpatient Hospital Services – Under Incarceration, clarified that inpatient hospital care includes inpatient psychiatric and inpatient rehabilitation services. Professional services associated with the covered inpatient hospital stay are also eligible for payment.

05-27-2016
Addition(s)/Revisions

Hospital Services

· Outpatient Hospital Services:

· Deleted the title "Outpatient Claims no Longer included on Inpatient claims" and added a link to the "MHCP Eligibility Beginning after the Date of Inpatient Admission" to clarify use of 837I Outpatient claim form when the first date of eligibility is same date as discharge date.

· Clarified the contradicting billing requirements in the Billing section, and deleted the bullet that said to bill covered and non-covered services on the same claim.

05-25-2016
Addition(s)/Revisions

Elderly Waiver (EW) and Alternative Care (AC) Program – Customized Living Services and Adult Foster Care Monthly to Daily Rate and Billing Code Transition effective July 1, 2016. Deleted references to class A and F licenses since credentials are just comprehensive license under Customized Living Services, Provider Standards and Qualifications.

05-20-2016
Addition(s)/Revisions

EIDBI

· Early Intensive Developmental and Behavioral Intervention (EIDBI) Benefit (PDF) – The billing grid Group Intervention (0366t/0367t) and Individual Intervention (0368t/0369t) codes have been updated to reflect the maximum number of providers per day per recipient. The grid's Individual Treatment Plan (ITP) development and monitoring code (H0032) section has been updated to reflect the new maximum units for the Initial and Additional ITP.

05-19-2016
Addition(s)/Revisions

Child and Teen Checkups (C&TC) - Added link to the Early Intensive Developmental and Behavioral Intervention (EIDBI) section of the manual in the Autism screening section.

05-12-2016
Addition(s)/Revisions

Individualized Education Program (IEP) Services

· Rates and Payments – Reviewed and clarified text throughout the Rates and Payments section of the Manual. Added instructions to access rate worksheet in MN–ITS mailbox under Interim Rates and Final Rates section of the Manual.

Intermediate Care Facilities (ICF/DDs) – Updated text to be consistent with DT&H, EW & AC, HCBS Waiver and Moving Home MN manual pages. Fixed some broken links and also broke up the Billing Guidelines section for how to bill on 837I and 837P to make it a little clearer.

05-11-2016
Addition(s)/Revisions

Provider Basics
Programs and Services

· Emergency Medical Assistance – Effective June 1, 2016, MHCP is contracting with a new medical review agent for Emergency Medical Assistance (EMA) Care Plan Certification (CPC) requests. Continue to submit requests to Telligen through May 27, 2016. On and after June 1, 2016, submit EMA CPC Requests to KEPRO via the KEPRO Provider Portal or by fax. We also added more detailed information about documentation requirements in the Requesting Care Plan Certification section.

04-27-2016
Addition(s)/Revisions

EIDBI

· Early Intensive Developmental and Behavioral Intervention (EIDBI) – Corrected age requirement to under 21 years of age and added provider travel time to Covered Services.

· Early Intensive Developmental and Behavioral Intervention (EIDBI) Benefit (PDF) – The grid has been updated to include which services require Service Agreements (SA), and supervising providers. Added another column for reimbursement percentages related to modifiers. Added additional maximum units for Family/Caregiver Training and Counseling codes, defined the difference between two different codes per each EIDBI service for EIDBI interventions.

Rehabilitative Services

· Augmentative Communication Devices – Added information about:

· In the Covered Services section added that electronic tablets must be locked to prevent use not related to communication unless covered under waiver programs and detailed explanation of electronic tablets as AC devices and speech-language pathologist's responsibilities

· In "Submit Documentation" added explanation of documentation requirements

· Clarification about Provider Reimbursement in the Billing section

04-26-2016
Addition(s)/Revisions

Community Health Worker (CHW) – Clarified the "Required Documentation" section to include the following:

· Who is allowed to sign an order for CHW services

· Added that documentation of the patient education plan or training program used by the CHW and documentation of the periodic assessment of recipients progress and need for ongoing CHW services must be included in the member's record

EIDBI

· Early Intensive Developmental and Behavioral Intervention (EIDBI) Provider Enrollment – Added the requirement of college transcripts on the enrollment page for each provider type except for the Level III providers.

HCBS Waiver Services

· Billing for Waiver and Alternative Care (AC) Program – Revised what is considered billable days for residential absences for disability waivers.

04-22-2016
Addition(s)/Revisions

MHCP Member Evidence of Coverage

· Added introductory text

· Added a statement in the “Welcome to MHCP” section directing members who have coverage through a health plan to the EOC for their health plan

· Added a statement to the “Paying providers” subsection under “Important information about getting the care you need” and the “Your member responsibilities” section that members may be responsible for the cost of services if they choose to get services from a provider not enrolled with MHCP

· Updated the “Cost sharing” section, including the “Copays” subsection, to reflect 2016 cost-sharing requirements

· Updated the “Noncovered services” and “Covered services” sections to note that, for services to be covered, they must be provided by an MHCP-enrolled provider

· Made the following changed under “Covered services”:

· Added an “Acupuncture” subsection

· Removed the bullet about acupuncture from the “Chiropractic care” subsection

· Added the following covered services to the “Hearing aids” subsection: personal communicators, FM systems and cochlear implants, with approved authorization

· Revised the “Medication therapy management” subsection to specify that a member must be taking at least one prescription, instead of three, to get the service

· Clarified the “Prescription drugs” subsections

· Added the following covered service to the “Rehabilitation services” subsection: augmentative communication or speech-generating devices

04-21-2016
Addition(s)/Revisions

Provider Basics

· Authorization – Corrected a typo on the new address for KEPRO.

04-15-2016
Addition(s)/Revisions

Provider Basics

· Billing Policy Overview – Added to the Prompt Payment section that claims with information in the notes or comments fields are considered complex. Removed references to paper claims in this section; MHCP requires electronic claims.

04-11-2016
Addition(s)/Revisions

Provider Basics

· Authorization – Updated address for KEPRO.

04-08-2016
Addition(s)/Revisions

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

· Changed age for family adult day services participants from 55 or older to 18 or older.

· Updated HCPCS codes for skilled nurse visit effective January 1, 2016.

04-07-2016
Addition(s)/Revisions

Child and Teen Checkups (C&TC)

· Developmental, social-emotional, and mental health: Added autism-specific screening and substance use assessment.

· Oral health: Added fluoride varnish application recommendation.

· Maternal depression screening: screening range has been extended for a mother of a child up through age 12 months. The number of screenings which will be paid through age 12 months has been increased.

· Newborn screening follow up: Listed as a separate screening component instead of listed in the laboratory test section.

· Fluoride Varnish Application (FVA): Policy related to definition of primary provider has changed. Primary providers or health professionals in the public health setting when trained staff are under the supervision of a treating primary care provider will use 99188 instead of D1206. After July 1, 2017, primary care providers or those under supervision of a treating primary care provider will no longer be allowed to use D1206.

· We provided additional and updated website resources.

03-31-2016
Addition(s)/Revisions

Anesthesia Services – CMS has corrected the 2016 Minnesota conversion factor amount from $21.50 to $21.13. MHCP will identify and reprocess claims processed between Jan. 1, and Mar. 15, 2016. This message will be updated once the remittance date is known.

03-30-2016
Addition(s)/Revisions

Reproductive Health

· Minnesota Family Planning Program (MFPP) – Added clarification for hormonal versus non-hormonal contraceptives.

03-23-2016
Addition(s)/Revisions

Mental Health Services

· Psychiatric Consultations to Primary Care Providers – Under Eligible Providers, we added two providers, licensed independent clinical social worker (LICSW) and licensed marriage and family therapist (LMFT), to the list of providers that can provide psychiatric consultation to primary care providers.

Programs and Services

· MHCP Benefits at-a-glance – Added program IM to the Benefits at a Glance chart and added links to other programs with limited benefit sets.

03-22-2016
Addition(s)/Revisions

Mental Health Services

· Certified Peer Specialist Services – Added demonstrates leadership and advocacy skills to the Certified Peer Specialist I requirements.

· Updated the certification requirements to include 76 hours of training that is approved by DHS and defining the 30 hours of CUEs should be related to peer support every two years.

· Defining covered services in more detail: Education and skill-building, including but not limited to Wellness planning Crisis planning Advanced Psychiatric Directives Self-advocacy skills including connecting to professional services when appropriate Services that help recipients Identify their strengths and to use their strengths to reach their treatment goals. Identify and overcome barriers to participation in community resources Connect with resources, Visiting community resources to assist them in becoming familiar with potential opportunities Teaching and modeling the skills needed to successfully utilize community resources Building relationships and encouraging community-based activities, Work Relationships Physical activity Self-directed hobbies Adding Transition to Community Living (TCL) services when working for a certified ARMHS provider..

03-18-2016
Addition(s)/Revisions

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

· Specialized Equipment & Supplies Authorization & Billing Responsibilities – Added clarification of what the modifiers mean.

Moving Home Minnesota – Fixed links, edited text for consistency (recipient to person) and moved "transition coordinator" paragraph around for better flow.

03-10-2016
Addition(s)/Revisions

Moving Home Minnesota

· Moving Home Minnesota Demonstration and Supplemental Services Table (PDF) – Family Memory Care Intervention ended 02/29/16 per policy decision.

03-08-2016
Addition(s)/Revisions

Transportation Services

· Acceptable Ambulance Diagnosis Codes – Added a clarifying statement that this list is only for claims with dates of service on or before September 30, 2015.

· Ambulance Transportation Services – Added authorization requirements information and moved information to this section from the Transportation Overview billing section that pertains specifically to billing for ambulance services. Removed references to ICD-9.

03-07-2016
Addition(s)/Revisions

Hospice Services

· Hospice Services – Changed Community Alternatives for Disabled Individuals (CADI) to Community Access for Disability Inclusion (CADI).

Individualized Education Program (IEP) Services

· IEP Billing and Authorization Requirements – Added text for limitations for mental health evaluations.

03-03-2016
Addition(s)/Revisions

Equipment and Supplies

· Patient Lifts and Seat Lift Mechanisms – Added a new bullet under Billing to allow higher reimbursement for E0635 eff. July 1, 2015, by billing with modifier U3.

03-02-2016
Addition(s)/Revisions

Laboratory/Pathology, Radiology & Diagnostic Services

· Laboratory/Pathology Services – In the Billing section:

· Under date ranges affected by this policy, deleted reference to billing on the 837P for dates of service on and after Oct. 1, 2015.

· Added a statement under Genetic Testing that pharmacogenetic panel tests such as those panel tests for psychotropics, analesics, or ADHD stimulant medications are not covered.

Pharmacy Services

· Home Infusion Therapy – Added modifiers to billing section for fee-for-service coverage for the two different vial sizes.

Reproductive Health

· Family Planning Codes with Increased Rates – Added non-hormonal OC/EC to J8499 and hormonal to S4993 codes for clarification to providers.

03-01-2016
Addition(s)/Revisions

Dental Services

· Authorization Requirement Tables for Non Pregnant Adults – Deleted discontinued code D5860 under Complete Overdenture and code D5861 under Partial Dentures.

02-29-2016
Addition(s)/Revisions

Dental Services

· Non-Dental Health Providers – Clarified who can bill for FVA and the addition of new CPT code 99188 for billing by primary care providers.

Reproductive Health/OB-GYN

· Doula Services – Added a link to the birth weight requirements in the Inpatient Hospital Services section.

· Free-Standing Birth Center Services – Added a link to the birth weight requirements in the Inpatient Hospital Services section.

02-26-2016
Addition(s)/Revisions

Rehabilitative Services

· Orthotic Procedures – Added HCPCS code L3981 under Fracture Orthoses.

02-25-2016
Addition(s)/Revisions

Acupuncture Services – Expanded the services eligible for coverage for acupuncture services and the number of services allowed annually; included more detail for noncovered services and authorization criteria; added a definition of "acupuncture practice."

Provider Basics
Billing Policy

· Payment Methodology - Non-Hospital – Under Waiver Services – 2015 Minnesota Legislature changed the name of the CADI Waiver from Community Alternatives for Disabled Individuals to Community Access for Disability Inclusion.

02-24-2016
Addition(s)/Revisions

HCBS Waiver Services

· HCBS Waiver Services – Consumer Training & Education was eliminated on the DD waiver and replaced with Family Training & Education which is on all waivers. Also changing Behavior Programming to Behavior Support, extended services home care to extended home care services (PDN to Home Care Nursing).

02-23-2016
Addition(s)/Revisions

Equipment and Supplies

· Positive Airway Pressure for Treatment of Obstructive Sleep Apnea – Removed link and reference to Benefits Code Guide because it is obsolete.

Eyeglass and Vision Care Services – Changed references to ICD-9 to ICD diagnosis code.

HCBS Waiver Services

· Billing for Waiver and Alternative Care (AC) Program – There is now one billing section for Waivers and AC program. Both HCBS Waivers and EW/AC manual sections will have one link.

02-19-2016
Addition(s)/Revisions

Community Health Worker (CHW) – In the Required Documentation section, added a non-enrolled registered nurse or public health nurse to the professionals who can sign an order for community health services.

Provider Basics

· Health Care Programs and Services Overview – Changed the name of the CADI Waiver from Community Alternatives for Disabled Individuals to Community Access for Disability Inclusion and fixed the link for the DD waiver under Waiver Services Programs.

02-17-2016
Addition(s)/Revisions

Provider Basics
Authorization

· Drug Authorizations – Clarified to send drug authorization requests to the prescription drug prior authorization agent, which is currently Health Information Designs (HID).

Hospital Services

· Critical Access Hospital (CAH) Services – Added new paragraph under the CRNA Services to explain the 2014 Legislative changes on how Hospitals must exclude Certified Registered Nurse Anesthetist (CRNA) charges from inpatient rates.

Individualized Education Program (IEP) Services

· Physical Therapy Services – Clarified text about telemedicine for physical therapy services under Covered Services.

Physician and Professional Services – Added dental hygienist, dental therapist, and advanced dental therapist as providers eligible to provide telemedicine services.

02-16-2016
Addition(s)/Revisions

Hospital Services

· Inpatient Hospital Authorization – Clarified text to the Subsection of "Criteria to Determine Medical Necessity".

Individualized Education Program (IEP) Services

· Billing and Authorization Requirements – Added modifier requirements for services provided via telemedicine.

· Speech and Language Pathology and Audiology Services – Clarified text about telemedicine and SLP services under Covered Services.

Laboratory/Pathology, Radiology & Diagnostic Services

· Laboratory Authorization Code List – Added two new genetic or hereditary testing codes to the code list.

Rehabilitative Services

· Rehabilitative Services Procedure Codes – Added CPT Codes 97607 and 97608.

02-11-2016
Addition(s)/Revisions

Dental Services

· Children and Pregnant Women – Added SDF to covered services, removed face to face requirements from oral evaluation.

· Non-Pregnant Adults

· Added code D1354 for Preventive Services

· Under Prosthodontics, added code range D5221–D5224 for partial dentures and deleted D5860 and D5861 for other removable prosthetic service

· Under Adjunctive Services, Oral and IV Sedation, deleted D9241–D9242 which are replaced with D9243

· Under Outpatient Dental Surgery Services, Adjunctive services, deleted D9220–D9221 and replaced with D9223

Individualized Education Program (IEP) Services

· Personal Care Assistance (PCA) Services – Changed text due to typo under Periodic Evaluations. It should have indicated in was the same person providing the PCA services (not the QP).

· Occupational Therapy Services (OT) Services – Deleted current text about telemedicine services, added new text to direct the reader to the Criteria for Providing Services via Telemedicine in the Covered and Noncovered IEP Health-Related Services section.

Provider Requirements – Added Home Care Nurse (HCN), Home Care Nursing (HCN) Agency, and Home and Community Based Services (HCBS) Alternative Care to provider types under Eligible Providers. Removed Registered Nurse (RN) or Licensed Practical Nurse (LPN) from the list.

02-10-2016
Addition(s)/Revisions

Dental Services

· Authorization Requirement Tables for Children and Pregnant Women – Code for overdenture was discontinued. Updated codes for overdentures.

Hospital Services

· Outpatient Hospital Services

· Added a new subsection called, "Outpatient Claims no Longer Included on Inpatient Claims". The update define the definition of covered days has changed: it no longer includes outpatient days in the covered days count as of October 1, 2015.

· Updated hyperlink that is listed under the subsection, "Inpatient Hospital Services When Inpatient Authorization is Denied".

· Updated the Billing section of Outpatient Services to include information that Outpatient hospital claims now have two place of service codes to select from, 19 (off-campus outpatient hospital) or 22 (on-campus outpatient hospital).

02-09-2016
Addition(s)/Revisions

Provider Basics
Billing Policy
Billing the Recipient

· Minnesota-defined U Modifiers - We made the following revisions:

· Added autism spectrum disorder screening in toddlers, 96110, to the U1 modifier.

· Separated Health Care Homes codes S0280 and S0281 into their own rows for U1 and U2 modifiers. Also included for each that U3 modifier is added if primary language is not English and U4 modifier is added if severe and persistent mental illness is indicated.

· Added S0209 and S0215 to the Access Transportation Services codes listed for the U2 modifier.

· Clarified enhanced service or item applies to sign language or eligible DMEPOS codes for the U3 modifier.

· Added emergency medical technician to the description of code T1016 for the U3 modifier.

· Separated Behavioral Health Homes codes S0280 and S0281 into their own rows for the U5 modifier.

· Corrected Children's Therapeutic Services and Supports (CTSS) to be listed for the UA modifier and clarified that all eligible CTSS codes apply.

· Added a link to the Provider Manual section for Early Intensive Developmental and Behavioral Intervention (EIDBI) services for the UB modifier.

Individualized Education Program (IEP) Services

· Covered and Noncovered Services IEP Health-Related Services – Added coverage criteria for Telemedicine for IEP Services.

· Personal Care Assistance (PCA) Services

· Overview: Removed eligibility requirements (moved to Eligible Recipient).

· Scope of PCA Services: Information added to define PCA involvement with assistance, cuing, Observation and Intervention or redirection.

· Covered Services: Minor wording change for ADL’s. Added text, clarification, provided examples for Level 1 behaviors, and behavior episodes.

· Noncovered Services: clarified continuous monitoring or observation.

· Activities Checklist: Added statement allowing the signature of a designated person who can verify services were performed, between QP evaluations.

· Supervision: Clarified information about who qualifies as a Licensed Qualified Professional.

· Plan of Care: Clarified required information for a Plan of Care.

· Other minor wording changes.

02-08-2016
Addition(s)/Revisions

Provider Basics
Provider Requirements

· Individual PCA Enrollment Criteria – Clarified processing timelines and how Provider Enrollment will handle application resubmissions. Provider Enrollment will no longer fax back resubmission requests. We will send resubmissions to the provider's MN–ITS mailbox.

02-04-2016
Addition(s)/Revisions

Early Intensive Development and Behavioral Intervention (EIDBI)

· Early Intensive Developmental and Behavioral Intervention (EIDBI) Provider Enrollment – Added additional information addressing the necessary steps for currently enrolled providers to add CMDE services, added enrollment sections for Levels I, II and II, and made other organization changes in the section.

02-03-2016
Addition(s)/Revisions

Mental Health Services

· Adult Rehabilitative Mental Health Services (ARMHS) – Updated the Covered Services section to clarify that all covered services are provided face-to-face, except Community Intervention. Documentation of activities is included in the covered service and must not be billed separately.

01-29-2016
Addition(s)/Revisions

Provider Basics
Billing Services
Billing the Recipient:

· Updated MinnesotaCare copays for 2016.

· Added statement that for emergency room visits for nonemergency services, a provider may not charge a recipient a copay if the provider is unable to locate a nonemergency provider for referral.

· Updated the family deductible for 2016 to $2.95.

· Added preventative services, smoking cessation treatments and prescriptions and immunizations to the copay and family deductible exclusions.

· Revised copay and family deductible limitations to extend the limit of 5 percent of gross monthly income to recipients with income over 100 percent of the federal poverty guidelines (FPG).

· Revised the policy on recipient inability to pay copay. The policy is no longer based on whether a program is state funded or federally funded. It is now based on whether the program is a Medical Assistance program or a MinnesotaCare program. See the section for exact details.

01-28-2016
Addition(s)/Revisions

Renal Dialysis

· Renal Dialysis - Method I – Added End Stage Renal Dialysis (ESRD) 50/50 Payment Rule information to Billing section.

01-22-2016
Addition(s)/Revisions

Provider Basics
Provider Requirements

· Provider Screening Requirements – We removed the Medicare Risk Levels table from this section and linked directly to the Medicare site for this information. We created a new section for the MHCP Risk Levels and Enrollment Verification Requirements. We also updated and revised the MHCP Revalidation schedule information to include when notices were sent.

01-15-2016
Addition(s)/Revisions

Immunizations & Vaccinations – CPT code 90713 – age change from 17 years and under to six weeks and older.

01-14-2016
Addition(s)/Revisions

Early Intensive Developmental and Behavioral Intervention (EIDBI)

· Early Intensive Developmental and Behavioral Intervention (EIDBI) Benefit (PDF) – Clarified the Level II provider requirements.

01-13-2016
Addition(s)/Revisions

Provider Requirements

· Risk Levels and Enrollment Verification Requirements – New manual section with a table listing by provider type the risk level assigned and whether a site visit or enrollment fee is required.

01-12-2016
Addition(s)/Revisions

Equipment and Supplies

· Ventilators – Under Covered Services, removed obsolete HCPCS codes for ventilators, E0450, E0460, E0461, E0463, and E0464, which are set to terminate 12/31/15, and added new codes E0465 and E0466 which are set to start effective 1/1/16. Also removed sentence in that section which reference positive and negative pressure ventilators.

Hospital Services

Inpatient Hospital Services

Updated the Billing section of Inpatient Hospital Services for the following:

(Note that the definition of covered days has changed; it no longer includes outpatient days in the covered days count as of October 1, 2015.)

· Inpatient Hospital Services when First date of Eligibility is Discharge Date: Submit charges incurred on the discharge date as outpatient via an outpatient claim form. No room and board will be allowed for the first day of eligibility.

· Inpatient Admission following Outpatient Services—Discharge date on or after October 1, 2015: Covered days are equivalent to the room and board days. Outpatient services were and continue to be included on the inpatient claim when outpatient services occur prior to admission.

· Birth Weight Requirement: MHCP now requires that all claims for babies less than 29 days include a birth weight. Effective for discharges on or after October 1, 2015, MHCP will deny claims that do not include a valid birth weight. The birthweight must be entered in grams.

· Under Covered Services, Incarceration: We updated text to show that effective for discharges on or after January 1, 2016, when an incarcerated person presents at a hospital and is discharged on the same date, no room and board day will be allowed. Bill charges incurred on the discharge day as outpatient claims via an outpatient claim form to the Department of Corrections or the responsible city or county correctional authority.

01-11-2016
Addition(s)/Revisions

Moving Home Minnesota

· Moving Home Minnesota Demonstration and Supplemental Services Table (PDF)

· MHM New services effective 01/01/16: S5111 U6 Home Care Training (family-per session), S5116 U6 Home Care training (non-family-per session), S5110 U6 Family Memory Care Intervention (15 min).

· Ending 12/31/15: T2013 U6 Post Discharge training and consult with provider to support placement.

· Replacing T2038 U6 UD with T1017 U6 (No SA required).

01-08-2016
Addition(s)/Revisions

Reproductive Health/OB-GYN

· Family Planning – Updated emergency contraceptive billing code. Was S4993; changed to J8499 for Family Planning. When billing MA use code J3490. Always bill with the NDC, drug name, dosage, and number of tablets dispensed in the comments.

Dental Services

· Critical Access Dental Payment Program (CADPP) – Legislation struck the rule for critical access dental that required private practicing dentists to not restrict access or services because of a patient's financial limitations or public assistance status.

Anesthesia Services – Added the 2016 Anesthesia Payment Rate Table.

01-07-2016
Addition(s)/Revisions

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

· Specialized Equipment & Supplies Authorization & Billing Responsibilities – Updated with an example of note under Lead Agency and Provider Responsibilities. Added modifiers on claims effective Jan. 1, 2016.

Previous Revisions

2015 Manual Revisions

2014 Manual Revisions

2013 Manual Revisions

2012 Manual Revisions

2011 Manual Revisions

Report this page