Explanation of Findings

Revised: October 17, 2022

· Overview

· Eligible Provider

· Eligible Members

· Covered Services

· Noncovered Services

· Billing

· Legal References

Overview

Explanation of findings means the explanation of a client's diagnostic assessment, psychological testing, treatment program or other accumulated data and recommendations to the client, client’s family, primary caregiver or other responsible people.

The purpose of explanation of findings is to discuss the results of the diagnostic assessment, psychological tests and other accumulated data and make recommendations about the member’s treatment plan.

The service is provided to members, the member’s family and caregivers or to others to help them better understand the member’s illness and provide professional insight needed to carry out a treatment plan.

Eligible Providers

Mental health professionals and clinical trainees are authorized to provide psychotherapy and conduct diagnostic assessments.

Eligible Members

All MHCP members are eligible.

Covered Services

The explanation of findings services include a face-to-face meeting between the mental health professional or clinical trainee and:

· The member

· Member’s family

· Primary caregiver

· Other responsible persons such as:

· Case manager

· Child protection worker

· Community corrections agency

· Guardian

· Health care provider

· Local education agency representative

· Qualified developmental disabilities professional (QDDP)

· School

· Vulnerable adult worker

· The mental health professional or clinical trainee providing the explanation of findings is required to obtain authorization from the member or the member’s representative prior to release of information.

Noncovered Services

Explanation of findings services do not include:

· Providing clinical direction of employees or students who provide mental health services under the treatment supervision of the mental health professional conducting the explanation of findings.

· Sharing information at regularly scheduled interagency coordination of care meetings where member care is discussed.

Explanation of findings are not paid separately when the results of the diagnostic assessment or psychological testing are explained as part of those services.

Authorization

Authorization is required to exceed two sessions per calendar year, maximum of four sessions per calendar year. To request authorization, submit an MHCP Authorization Form (DHS-4695) (PDF) with the following documentation:

· Explanation of who attended the meeting

· Copy of the diagnostic assessment or testing results that were explained

Billing

· Bill an explanation of findings using MN–ITS 837P

· Add appropriate modifier when mental health practitioner working as a clinical trainee renders service

Explanation of Findings Billing

Procedure Code	Modifier	Brief Description	Unit	Limitation
90887		Explanation of findings	1 session	Up to two sessions per calendar year without authorization. Maximum of four sessions per calendar year.
90887	HN	Explanation of findings conducted by clinical trainee	1 session
Teaching hospitals may enter the GC modifier for services performed under the direction of a supervising physician.

Legal References

Minnesota Statutes 256B.0671, subdivision 4