MHCP Provider Manual
2017 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.
December 2017
12-27-2017
Addition(s)/Revisions |
Provider Basics
Provider Requirements · Provider Screening Requirements – Under Application Fees, we added that the fee for institutional providers is $569 for each practice location effective Jan. 1, 2018. |
12-22-2017
Addition(s)/Revisions |
Dental Services (Overview) – Under General Billing Guidelines we added that effective for dates of service on or after Jan. 1, 2017, payment rates increased by 9.65 percent for dental services performed outside of the seven-county metropolitan area, which includes the counties of Anoka, Carver, Dakota, Hennepin, Ramsey, Washington and Scott. |
Elderly Waiver (EW) and Alternative Care (AC) Program · We moved the environmental accessibility adaptations policy information to the Community-Based Services Manual (CBSM). A link has been added to the environmental accessibility adaptations section of the table to the information in the Community-Based Services Manual.· We deleted the EW/AC transportation policy reference that providers cannot bill for transportation and other services on the same day. Transportation and other services may be billed on the same day, but not concurrently. |
Rehabilitation Services · Augmentative Communication Devices – Added coverage criteria about the face-to-face encounter required for augmentative communication devices effective July 1, 2017. The revision includes a link to the Equipment and Supplies section which details the face-to-face rule requirements. |
12-19-2017
Addition(s)/Revisions |
Mental Health Services · Diagnostic Assessment – We updated the criteria for what is included in a brief diagnostic assessment per new legislation. The information that needs to be included in a brief diagnostic assessment has been changed as well as when a provider may use a brief DA. Also, the number of psychotherapy allowed before the completion of a diagnostic assessment has been raised to three per legislation. |
Mental Health Services · Diagnostic Assessment (DA) Report Components· We revised the brief diagnostic required components to reflect the legislative changes to remove the following previously required components: · Current living situations, including household membership and housing status· Basic needs status including economic status· Education level and employment status· Significant personal relationships, including the client's evaluation of relationship quality· Strengths and resources including the extent and quality of social networks· Belief systems· General physical health and relationship to client's culture· Current medications· The following required components were added:· History of mental health treatment including review of records· Cultural influences and impact |
12-07-2017
Addition(s)/Revisions |
Moving Home Minnesota (MHM) · Moving Home Minnesota Supported Employment Services (MHM SES)· In the Overview we changed the age from 65 to 60 and deleted the words "minimum or prevailing wage." · We clarified the required training for Moving Home Minnesota (MHM) providers to state that the Association of Community Rehabilitation Educators (ACRE) must approve the training curriculum.· In the Billing section, we explained the two-step process for billing for the incentive benchmark payment for supported employment and added a link to the online form Moving Home Minnesota Milestone Form (DHS-6759L) |
12-05-2017
Addition(s)/Revisions |
Equipment and Supplies · Pressure Reducing Support Surfaces – The prior authorization requirement for Group 2 and 3 pressure reducing support surfaces has been changed from monthly to every six months. |
Individualized Education Program (IEP) Services – Added links to services under Covered and Noncovered Services. |
Mental Health Services · The Mental Health Diagnostic Code Range table has been updated the diagnosis codes are effective October 1, 2016, per ICD 10 guidelines. The following changes have been made: · Mental Health Diagnostic Code Ranges has been revised, removing repetitive information that appears in text and in table format.· Added the following :· Disorder of adult personality and behavior (F60-F68.89)· Pervasive and specific developmental disorders (F80.81-F89)· Behavioral and emotional disorders with onset usually occurring in early childhood and adolescence (F90-F98.9) |
12-01-2017
Addition(s)/Revisions |
Equipment and Supplies · Mobility Devices – We made the following changes to this section:· Under Custom Molded and Prefabricated Custom Seating Systems, the requirement of a power wheelchair being considered in a long-term care facility only if it allows the recipient to complete most activities of daily living independently has been removed and replaced with:· Authorization for a power wheelchair will be considered only if it allows the recipient to experience inclusion and integration in the long-term care facility. Documentation must demonstrate the absence of a progressive condition. · Under Use of Modifiers, the KC and KE modifiers have been removed from this section. The KC and KE modifiers have been removed and replaced with Medicare in the title of this section. Follow Medicare guidelines for the use of current Medicare modifiers. |
November 2017
11-30-2017
Addition(s)/Revisions |
Immunizations & Vaccinations – We added a new influenza vaccine code 90682 and new zoster (shingles) code 90750. |
Pharmacy Services – This revision clarifies the prohibition against auto-refills and addresses general, non-policy related, clean-up of outdated information. This revision also clarifies that paper pharmacy claims are not accepted and MA members may pay cash for phentermine as it is not included in the MA benefit. |
11-22-2017
Addition(s)/Revisions |
Provider Basics
Programs and Services · Emergency Medical Assistance – We have updated the Emergency Medical Assistance information on PCA services and drug requests to better explain the processes and forms required. |
11-17-2017
Addition(s)/Revisions |
Mental Health Services · Intensive Treatment in Foster Care – Intensive treatment services in foster care is a new MHCP reimbursable service. The manual page is now completed for existing and interested providers. |
11-16-2017
Addition(s)/Revisions |
| Hospital Services – We added the word "hospital" after the subheading local trade area. |
Individualized Education Program (IEP) Services · Covered and Noncovered IEP Health-Related Services – We added a section title for telemedicine. We also added a statement to clarify if the school is evaluating a child for the sole purpose of identifying the health-related needs of that child for the child's IEP or IFSP, MA will cover the time spent performing that evaluation or assessment even if the service does not get added to the IEP or IFSP or result in an IEP or IFSP. |
11-09-2017
Addition(s)/Revisions |
Provider Basics
Provider Requirements · Provider Requirements - Rule 101 – We made changes to the application of Rule 101 caseload limits for dental providers. Effective July 1, 2017, dental practices located outside of the seven-county metro area who want to be paid for other state-sponsored health care programs are not subject to the required 10 percent annual active caseload. |
Provider Basics
Provider Requirements · Provider Screening Requirements – We updated language to indicate MHCP continues required revalidation, and clarified provider revalidation process and timeline. We removed:· exceptions section that is no longer applicable· outdated revalidation schedule· outdated revalidation fee, left current revalidation fee amount |
October 2017
10-30-2017
Addition(s)/Revisions |
Mental Health Services – The Mental Health page has been updated to correct the LOCUS link. The link that previously directed a provider to DHS form 6249 now links to the LOCUS provider manual page. |
10-24-2017
Addition(s)/Revisions |
Individualized Education Program (IEP) Services · Covered and Noncovered IEP Health-Related Services – Added a new subsection to clarify coverage for evaluations, reevaluations and assessments needed to determine eligibility for covered services. This incorporates the change in wording from the 2017 legislation with an effective date of Aug. 1, 2017. Added information under Telemedicine about requirement to use place of service 02 for services provided at a distant site via telemedicine. |
10-19-2017
Addition(s)/Revisions |
Alcohol and Drug Abuse Services · Telemedicine – the telehealth section of the MHCP manual has been added as a sub-section of the Alcohol and Drug Abuse MHCP manual section. This section was in added as starting 10/1/2017, SUD treatment providers may use telemedicine in the delivery of individual, non-residential SUD treatment for MHCP eligible recipients. |
Hospital Services · Inpatient Hospital Services – In the section Inpatient Stays that Exceed 180 Days, we clarified that this applies for the admission dates between November 1, 2014, and June 30, 2017. The differential billing requirement ends for admissions on or after July 1, 2017. |
Provider Basics
Billing Policy (Overview) · Payment Methodology – Hospital – Added the following information to the Outpatient Hospital Legislative Ratable Add-On subsection: · 3 percent for outpatient hospital services effective September 1, 2014 · 90 percent provided by an essential community provider that was formerly a state hospital effective July 1, 2015 |
10-17-2017
Addition(s)/Revisions |
Child and Teen Checkups (C&TC) – We revised the C&TC section to reflect the revised Minnesota Child and Teen Checkups (C&TC) Schedule or Age-Related Screening Standards (DHS-3379) (PDF), which is effective October 1, 2017. Content has been updated throughout this section. |
10-16-2017
Addition(s)/Revisions |
Dental Services · Critical Access Dental Payment Program (CADPP) – Added that providers need to submit their patient encounters to DHS annually using form DHS-7602. Also, changed the fax number to submit forms DHS-2669 and DHS-2669A. |
Hospital Services · Inpatient Hospital Services – We deleted the subsection FFS and MCO Transition During Inpatient Hospital Stay under Billing. Fee for service pays for the hospitalization when the patient is admitted under FFS and this does not affect payment if the member moves to an MCO during the hospitalization so this information is not needed. |
September 2017
09-22-2017
Addition(s)/Revisions |
Equipment and Supplies · In Billing and Documentation, under Detailed Written Orders, we added that an order must contain handwritten or electronic signature and linked to Minnesota Rules about electronic signatures.· In the Face-to-Face rule section: · We removed the requirement of clinical nurse specialists and nurse practitioners working in collaboration with a physician because this is no longer required · We updated the link for DME subject to the face-to-face rule · We added non-physician practitioner to documentation for the medical supplier's records and physician or non-physician practitioner to documentation of a phone call. |
Equipment and Supplies · Airway Clearance Devices – Added in Covered Services that MHCP covers a detachable battery and car charger for a cough stimulating device. |
09-20-2017
Addition(s)/Revisions |
Behavioral Health Home Services – BHH policy has changed and providers are no longer required to have face-to-face contact with clients every 60 days. Providers must have personal contact with client at least once per month to bill for BHH services. |
Provider Basics
Billing Policy · Payment Methodology – Hospital – Updated this page to reflect current payment methodology for hospitals. Also took action on the following subsections: · Clarified the paragraph explaining about critical access hospitals. · Clarified the Outpatient Hospital Facility section. · Replaced the Policy Adjuster Values table for Nov. 1, 2014, to current date with a hyperlink to table in eDocs: Policy Adjuster Values Table (DHS-7619) (PDF). |
09-18-2017
Addition(s)/Revisions |
Provider Basics
Provider Requirements · Access Services – Added definition of telemedicine and interactive audio and video telecommunications, and updated GT and U4 definitions to meet AUC criteria. |
09-07-2017
Addition(s)/Revisions |
Provider Basics
Billing Policy · Payment Methodology - Non-Hospital – Updated "Transportation Services" section for transportation service reference to "non-emergency medical transportation" (NEMT), local agency and state administered NEMT, and the end date for proration of NEMT. |
August 2017
08-29-2017
Addition(s)/Revisions |
Anesthesia Services – Clarified where to place the AA modifier on a claim for correct payment under Billing. |
08-23-2017
Addition(s)/Revisions |
Provider Basics · Billing Policy Overview – Removed reference to ICD-9 since this is no longer valid. |
Renal Dialysis Overview – Changed the layout of the Renal Dialysis Overview page to be the main page for renal dialysis. These changes will not have any impact on billing for renal dialysis. The following changes were made to this page: · Under subheading, "ESRD" we deleted the hyperlink to Method I and Method II, and updated the language for ESRD billing · In the Subheading "Billing", we added a hyperlink to the Renal Dialysis Billing page · We moved subheading and content of " Outpatient ESRD-Related Services" into the hyperlink "Renal Dialysis Billing" · We moved subheading and content of "Inpatient Billing/Non-CAP Payment” into the hyperlink "Renal Dialysis Billing" · Added definition for " Composite Rate"· Deleted definition for Method I - Composite Rate· Deleted definition for Method IIRenal Dialysis Billing – We changed the layout of this page to reflect current billing acronyms and text used for renal dialysis billing. These changes and updates will not have an impact on how renal dialysis is currently billed. The following changes have been made to this page: · The page is now titled Renal Dialysis Billing. · In the Renal Dialysis Overview section, we changed "Method I" to composite rate. · Section links were added to the top of the page for quick access to specific billing information.Renal Dialysis Method II – This section has been removed from the manual and the information has been moved to the Renal Dialysis Overview and Renal Dialysis Billing sections. |
08-10-2017
Addition(s)/Revisions |
Transportation Services · State-Administered NEMT – Replaced outdated terminology, "special transportation," with current terminology, state-administered transportation. Also, changed the procedure codes under the billing example to mode 5 instead of mode 4 to lessen confusion. |
08-09-2017
Addition(s)/Revisions |
Early Intensive Developmental and Behavioral Intervention (EIDBI) · Early Intensive Developmental and Behavioral Intervention (EIDBI) Benefit Chart – Updated Billing Grid. Removed the limit of 130 hours in 6 months from EIDBI Observation and Direction codes 0362T and 0363T. Increased the provider limit from 4 to 6 providers a day for EIDBI Intervention. Adjusted the limit on EIDBI Intervention codes 0364T/ 0365T and 0368T/ 0369T to "an average of 40 hours per week" rather than "a maximum of 40 hours per week," to allow medically necessary variance. Updated ITP progress monitoring units to indicate maximum in a 6 month period vs. per year to be consistent with other services. |
08-08-2017
Addition(s)/Revisions |
Provider Basics
Programs and Services · Emergency Medical Assistance (EMA) – Added a link to the End Stage Renal Disease section from the top of this section. |
July 2017
07-26-2017
Addition(s)/Revisions |
Hospital Services · Inpatient Hospital Authorization – Revised and clarified the language in the subsection, "Concurrent, Continued Stay & Retrospective Reviews" so that it follows legislative changes from Minnesota Statutes 2016, section 256b.0625, subdivision 1. Also added the updated Minnesota Statues 2016, section 256b.0625 to the Legal References section.· Inpatient Hospital Services – Updates to medical necessity definition and removal of Pay for Performance Program section as that program no longer exists. |
Provider Basics
Programs and Services
Emergency Medical Assistance (EMA) · End Stage Renal Disease (ESRD) – Emergency Medical Assistance guidelines have been developed to improve transparency for providers regarding covered and noncovered medications for members eligible under EMA who have End Stage Renal Disease and are undergoing dialysis. |
07-24-2017
Addition(s)/Revisions |
Dental Services · Critical Access Dental Payment Program (CADPP) – For MinnesotaCare services provided on or after July 1, 2017, the reimbursement will change from 32.5 percent above the MHCP maximum allowable rate to 20 percent above the allowable MHCP allowable rate. |
07-17-2017
Addition(s)/Revisions |
Child Welfare Targeted Case Management (CW-TCM) – Bullet number 11 under Noncovered Services section has been clarified to include the discharge planning provision found in the covered services section, and now reads as follows: CW-TCM services for children in an Institution for Mental Disease (IMD) (usually for CD treatment) or a state-operated corrections facility or the secure unit of any residential facility unless it is for discharge planning as stated under the Covered Services section. |
07-07-2017
Addition(s)/Revisions |
Elderly Waiver (EW) and Alternative Care (AC) Program – Updated Residential Care Services section with information regarding the discontinuation of the service. |
Equipment and Supplies – Effective July 1, 2017, a physician, physician assistant, nurse practitioner, or a clinical nurse specialist (excluding certified mid-wives, audiologists, and podiatrists) is required to maintain documentation of face-to-face encounters for certain medical equipment, appliances and supplies within six months before the start of service (initial dispensing date). A link to the list of DME items subject to the face-to-face rule is included in the revision. |
07-05-2017
Addition(s)/Revisions |
Equipment and Supplies · Transfer and Mobility Device (TRAM) – New policy added for the TRAM transfer and mobility device. This device has a gait training function, sit-to-stand function, and seated transfer function. |
07-03-2017
Addition(s)/Revisions |
Certified Community Behavioral Health Clinic (CCBHC) Federal Demonstration Project – The Certified Community Behavioral Health Clinic (CCBHC) Federal Demonstration Project page has been added to the MHCP Provider Manual. Minnesota certified six participating clinics as meeting the federal certification criteria for the demonstration program effective July 1, 2017, through June 30, 2019. |
June 2017
06-28-2017
Addition(s)/Revisions |
Provider Basics
Programs and Services · MHCP Benefits at-a-glance – Removed coverage indicator under MinnesotaCare program LL for Individualized Education Program (IEP) services to align with Basic Health Plan coverage. |
06-20-2017
Addition(s)/Revisions |
Equipment and Supplies · Diabetic Equipment & Supplies – Two codes have been added to the HCPCS codes set for continuous blood glucose monitoring effective July 1, 2017:1. K0553 Supply allowance for therapeutic continuous glucose monitor (CGM) includes all supplies and accessories, 1 unit of service = 1 month's supply2. K0554 Receiver (Monitor), dedicated for use with therapeutic continuous glucose monitor system· Mobility Devices – Under Power Wheelchairs subsection, changed language to conform with policy to state that providers may not bill the codes listed within 30 days of initial issue of a power wheelchair. |
Transportation Services · Nonemergency Medical Transportation (NEMT) Services (Overview) – Made update to proration policy and removal of Medica withdrawal from MCO responsibilities. |
06-13-2017
Addition(s)/Revisions |
Provider Basics
Programs and Services · MHCP Benefits at-a-glance – Updated table including: added a separate column for Program IM; added Program XX to column for Program BB; added the services acupuncture, CEMT, community paramedic services and EIDBI; and made updates to covered services for several programs. |
05-26-2017
Addition(s)/Revisions |
Dental Services (Overview) · Non-Pregnant Adults – Prior authorization is not required for scaling and root planning procedures for the limited benefit set; however, they can only be performed in outpatient hospitals and ASC (not in the office). |
May 2017
05-22-2017
Addition(s)/Revisions |
Equipment and Supplies · Nebulizers – Policy for nebulizers added to the MHCP Provider Manual. |
Programs and Services · Program HH Dental Authorization Requirement Chart – Removed implant criteria, Program HH does not cover implants. Added many more codes for crowns and pontics (fixed partial dentures). Program HH will now cover more than just stainless steel crowns. Updated prior authorization criteria for crowns and pontics. Removed the age limit for crowns and pontics. Removed the criteria that the client had to have a reason they could not function with a removable denture. |
05-18-2017
Addition(s)/Revisions |
Hospital Services · Inpatient Hospital Services – We updated the inpatient hospital payment methodology for prospective payment system (PPS) hospitals. We modified the PPS rates for claims with lengths of stay over 180 days and added instructions in the billing section for inpatient stays that exceed 180 days. |
05-03-2017
Addition(s)/Revisions |
Provider Basics · Health Care Programs and Services Overview – Clarified major programs and descriptions for most programs listed in the chart. Added major program XX – state-funded MinnesotaCare for certain noncitizens 21 or older. |
Tribal and Federal Indian Health Services – We made extensive edits throughout this section. Highlights of changes include the following; however, these are not all of the changes: · Under Eligible Providers we clarified exceptions for tribal and IHS providers meeting the same service and licensure requirements as all other MHCP-enrolled providers · Under Billing:· We clarified information about the provider number· We added information about when to bill MHCP or the managed care organization· We added telemedicine to the list of service categories eligible for reimbursement at the Indian Health Services outpatient reimbursement rate· We removed the outpatient encounter rate information for transportation servicesWe need to make additional edits and will continue to update this section of the manual; please watch for further announcements of changes. |
05-02-2017
Addition(s)/Revisions |
Provider Basics
Billing Policy · Minnesota-defined U Modifiers – Added to the following:· U5: GRH supplemental services H0043 and H0044· U6 for MHM: S5111 replaced T2013, S5116, T2038. Also added mod UA for S5135 and UB for S5150.· U7: ADC, FADS S5100 for all waivers, ECS, and AC and ADC, FADS S5102 for all waivers and AC· U9: 24 hour CLS foster care under age 65 T2031 TG · UC: Transportation (waiver, one-way trip) T2003 and (mileage) S0215 · UD: Assistive technology assessment · Removed from U9: Behavioral program by aide |
April 2017
04-26-2017
Addition(s)/Revisions |
Hospital Services · Critical Access Hospital (CAH) Services – We revised this section throughout to reflect the new payment methodology for critical access hospitals. Changes include the following:· Under Outpatient Payments we added the formula and process of how the payment rate through fiscal years ending in 2016 and in 2017 are determined.· Under Inpatient Payment we clarified that payment for inpatient hospital services has moved to a tiered per diem payment effective for discharges on or after July 1, 2015, and added a section about New Cost-Based Inpatient Payment Methodology. We also clarified the date of admission for admissions prior to October 1, 2015, and discharges on or after October 1, 2015. |
Mental Health Services · Adult Day Treatment· The following information has been updated under Admission Criteria:· An FA must also be completed prior to receiving services and no sooner than 30 days prior. An FA is valid for 180 days· A LOCUS must also be completed prior to receiving services and no sooner than 30 days prior.· The following information has been added to Covered Day Treatment Services: · Be completed before the completion of five working days in which service is provided or within 30 days after the diagnostic assessment is completed or obtained, whichever occurs first. · The ITP and subsequent revisions of the ITP must be signed by the client before treatment begins. The mental health professional or practitioner shall request the client, or other person authorized by statute to consent to mental health services for the client, to sign the client's ITP or revision of the ITP.· If the client or authorized person refuses to sign the plan or a revision of the plan, the mental health professional or mental health practitioner shall note on the plan the refusal to sign the plan and the reason or reasons for the refusal. |
Mental Health Services · CTSS Authorization Codes – This page has been deleted because it was duplicative of information found in the Billing section of the CTSS section in the Provider Manual. |
04-21-2017
Addition(s)/Revisions |
Hospital Services · Outpatient Hospital Services – Added in Billing that E&M services are priced using a composite rate when there are eight or more hours of observation. |
March 2017
03-15-2017
Addition(s)/Revisions |
Individualized Education Program (IEP) Services · Interpreter Services – Clarified under Overview when Medical Assistance will reimburse for interpreter services and under Sign Language Interpreter Services that inclusion on the Minnesota Department of Health roster is not evidence that the person is certified as an interpreter. |
03-07-2017
Addition(s)/Revisions |
Equipment and Supplies · Nutritional Products and Related Supplies – Minor revisions due to 2017 HCPCS changes. Changed code for feeding pumps from B9000 to B9002. Added information for repairs to pumps originally dispensed at B9000 in the Billing subsection. |
03-02-2017
Addition(s)/Revisions |
Behavioral Health Home Services – The BHH services section of the MHCP Provider Manual has been updated with the following: · Clarify that there is not a particular order in which providers must assess eligibility for BHH services; simply that they must ensure that all criteria have been met· Clarify that provider type is required if BHH services provider is billing using a billing entity· Clarify that BHH providers must submit claims that correspond with the BHH services certification approval letter |
Early Intensive Developmental and Behavioral Intervention (EIDBI) · Early Intensive Developmental and Behavioral Intervention (EIDBI) Benefit Grid – Updated provider limits and service limits on the EIDBI billing grid. |
February 2017
02-24-2017
Addition(s)/Revisions |
Equipment and Supplies · Oxygen Equipment· Clarified billing policy for dually eligible recipients in long-term care facilities. · Added that MHCP does not cover the following:· Stands, racks, and wheeled carts for oxygen equipment· Replacement accessories for portable concentrators |
Provider Basics
Billing Policy · Payment Methodology – Hospital – General clarifications throughout the section, including the following:· Revised and updated this section to reflect the Legislation that passed in 2013 directing DHS to develop new payment methodologies for fee-for-services (FFS) inpatient hospital services provided by diagnosis related group (DRG) hospitals, critical access hospitals, and rehabilitation hospitals · Deleted outdated information about programs or services that have ended · Updated the Critical Access Hospital subsection to reflect the new MHCP cost-based inpatient payment methodology according to the 2013 legislative directive· Deleted the outdated process of appeal for case mix procedure · Updated the Inpatient Hospital Services subsection to show the new payment methodologies for fee-for-services (FFS) inpatient hospital services provided by diagnosis related group (DRG) hospitals, as directed in the 2013 legislation · Updated and clarified some of the definitions |
02-06-2017
Addition(s)/Revisions |
Individualized Education Program (IEP) Services · IEP Providers – IEP provider contact list updated with new DHS email address for sending in new or updated contact information. |
Mental Health Services · Adult Rehabilitative Mental Health Services (ARMHS) – The billing table has been changed to add updates to ARMHS coding for transition to community living. Modifier UD has been updated to U3 and now reads as follows:· H2017 U3 - Basic living and social skills, transitioning to community living (TCL)· H2017 U3 HM - Basic skills, transitioning to community living (TCL) by a mental health rehabilitation worker |
Provider Basics
Provider Requirements · Access Services – Added process for authorization of interpreter units after the allowed 8 units for a single date of service. |
January 2017
01-20-2017
Addition(s)/Revisions |
Equipment and Supplies · Mobility Devices – Minor revisions to reflect changes to HCPCS codes that include the following:· Added manual wheelchair accessory code K0077· Under Wheelchair Options and Accessories:· Added E1012 to power leg elevation systems· Added E1014 to manual, fully or semi-reclining backs. |
Laboratory/Pathology, Radiology & Diagnostic Services · Laboratory and Pathology Services - Under Drug Testing we:· Changed HCPC codes G0477- G0479 to CPT codes 80305-80307 or G0480 – G0483 per encounter for dates of service on and after January 1, 2017. · Clarified that effective November 1, 2016, codes 80300-80304 and 80320 – 80377 are no longer covered· Added that effective January 1, 2017, codes G0477 – G0479 will be deleted |
Mental Health Services · Psychotherapy – Clarified billing for codes 90846-90849 that are used to report family psychotherapy. Family psychotherapy coding may be separately reported for each patient in the family group, however, it should not be reported for each family member. |
Reproductive Health/OB-GYN · Minnesota Family Planning Program (MFPP) – Added covered diagnosis code range to the Covered Services section. |
01-17-2017
Addition(s)/Revisions |
Laboratory/Pathology, Radiology & Diagnostic Services · Radiology/Diagnostic Services – Updates under Billing subsection for Medicare outpatient hospital changes effective 2016 and 2017 for computed tomography modifier CT, x-rays taken by film (requiring modifier FX) and stereotactic radiosurgery planning and delivery modifier CP. |
01-04-2017
Addition(s)/Revisions |
Mental Health Services · Adult Day Treatment – Added an Overview section defining what constitutes a day treatment service and the MN statutes that explain what facilities can provide the service.· Adult Rehabilitative Mental Health Services (ARMHS) – Updated adult rehabilitative mental health services (ARMHS) definition to reflect MN Statute 256B.0623, Subd. 2. Updated modifiers for HCPS codes H0031 and H0032 on billing grid. The following changes were applied to the billing table:· H0031 Brief Description changed from Functional Assessment to Mental Health assessment by non-physician and the UD modifier was added. · Modifier UD was added to the TS modifier for H0031 Functional Assessment Update/Review. · The UD modifier was added for procedure H0032 Individual Treatment Plan. · Modifier UD was added to the TS modifier for H0032 Individual Treatment Plan Update/Review. · Per 15 minutes was added to the unit section of the billing table for the services, Functional Assessment, Mental Health Assessment (H0031 UD/H0031 UD TS) and Functional Assessments (H0032 UD/H0032UD TS). |
Provider Basics
Provider Requirements · Provider Screening Requirements – Updated text from old fee amount to new fee amount.· Risk Levels and Enrollment Verification Requirements – Changed provider type 72 from broker to coordinator to more closely fit the definition of enrolled provider type 72. |
Rehabilitative Services · Rehabilitative Services Procedure Codes – Added new 2017 OT/PT evaluation codes and updated some code descriptions. |
Previous Revisions
2016 Manual Revisions
2015 Manual Revisions
2014 Manual Revisions
2013 Manual Revisions
2012 Manual Revisions
2011 Manual Revisions
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