Inpatient Visits

Revised: October 17, 2022

· Overview

· Eligible Providers

· Eligible Members

· Covered Services

· Billing

· Definitions

· Legal References

Overview

Minnesota Health Care Programs (MHCP) covers inpatient visits. Hospitalized MHCP-enrolled members are eligible to receive psychological care when admitted to a hospital for a medical reason.

Eligible Providers

The following may provide mental health inpatient visits:

· Clinical Nurse Specialist-Mental Health (CNS-MH)

· Licensed Psychologist (LP) (with a physician’s order)

· Physicians

· Psychiatric Nurse Practitioner (NP)

· Psychiatrists

Physician assistants (PA) are eligible to provide evaluation and management services, consistent with their authorized scope of practice, in an inpatient hospital setting when supervised by an MHCP-enrolled physician or psychiatrist. A PA may not provide psychotherapy, diagnostic assessment or treatment supervision.

Eligible Members

Hospitalized Minnesota Health Care Programs (MHCP) enrolled members are eligible for inpatient mental health visits.

Covered Services

Covered inpatient visit services include:

· Hospital evaluation and management (E/M) services and psychiatric services, when billed according to the service requirements

· Medical care a medical physician provides during the same day that a psychiatrist, CNS-MH, or psychiatric NP provides mental health services

· Psychiatric care ordered by a physician or psychiatrist when a member is admitted to an inpatient hospital for medical reasons

· One visit per day, of the same service, by the same physician

Billing

Follow these guidelines when billing inpatient visits:

· Use the MHCP MN–ITS 837P to bill for physician and non-physician services

· Enter the treating provider NPI number on each claim line

· Enter place of service code 21 for all visits in an inpatient setting

· Use the appropriate level procedure codes for all services

· Use the appropriate modifier when billing for interns or residents

Only a psychiatrist, CNS-MH or psychiatric NP may bill for inpatient visits and receive the professional fees (not included in the facility payment) when an MHCP member is admitted to an inpatient hospital.

MHCP will reimburse the psychiatric NP or CNS-MH services in the inpatient setting if the individual is not employed by the hospital or included in the hospital cost report that is currently used for hospital rate setting. The cost report used for the current rates is always from a few years before the current year.

See Physician Consultation, Evaluation and Management for covered service policy when a psychiatrist requests a medical physician to assume responsibility for managing a member’s non-psychiatric medical care.

Refer to the Psychotherapy section when providing inpatient Psychotherapy services.

Procedure Code	Brief Description	Service Limitations
99221—99223	Inpatient Hospital Care	· Psychiatrist is admitting physician for initial hospital visit or medical physician performs a physical exam as part of admission process · Only admitting physician uses initial hospital care code · Preliminary diagnosis and plan of care are part of the initial visit
99231—99233	Subsequent Hospital Care	Medical physician manages member’s non-psychiatric medical care after initial inpatient hospital consultation
99251—99255	Initial inpatient consultation	A physician requests a consultation. Must see the patient face to face.

Definitions

E/M: Evaluation and Management (EM) codes are used to report services provided in a physician's office or outpatient or other ambulatory facility or services provided to an individual who is an inpatient in a hospital. For mental health services, providers must follow the CPT guidelines when using these codes unless otherwise specified in the coverage text for a mental health service as stated in this chapter.

Legal References

Minnesota Statutes 256B.0625, Covered Services