MHCP Provider Manual

2024 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 31, 2024

Reproductive Health/OB-GYN

· Home Birth – The Minnesota Department of Human Services will cover home birth services effective Jan. 1, 2025, as part of its Minnesota Health Care Programs (MHCP). Refer to the new Home Birth section in the MHCP manual page for complete policy details.

December 27, 2024

Equipment and Supplies

· Equipment and Supplies – We updated the Orthotics section title to Orthotics and Prosthetics.

· Orthotics and Prosthetics

· Under Covered Services we added MHCP now covers orthotic and prosthetic devices for purposes of bathing and showering and for purposes of recreation.

· Under the Billing heading, we added modifier information for devices for bathing or showering and devices for recreational purposes.

· We moved information from the Lower Limb Prosthetics section of the MHCP Provider manual into this manual section and deleted the Lower Limb section of the MHCP Provider Manual.

· Lower Limb Prosthetics – We moved the information about coverage for lower limb prosthetics to be under Orthotics and Prosthetics.

Rehabilitation Services

· Rehabilitative Services

· Under the Eligible Ordering and Referring Providers heading, we added optometrists as providers that can refer for PT and OT services for low-vision rehabilitation.

· Under the Definitions heading, we added optometrists as practitioners of the healing arts.

December 19, 2024

Housing Stabilization Services

· Housing Stabilization Services

· Under the Documentation requirements heading, we added links to legal references and included documentation needs for remote support.

· Under the Legal References heading, we added appropriate links to Minnesota statute, rule and state plan amendment.

Equipment and Supplies

· Nutritional Products and Related Supplies

· Under the Covered Services heading, we updated to include coverage for amino-acid based elemental formula.

· Under the Authorization Requirements heading, we state authorization is required for amino-acid based elemental formula for members older than 5 years old.

December 17, 2024

Immunizations and Vaccinations

· Immunizations and Vaccinations

· Under Billing, Billing for Child Vaccines, we removed CPT Administration Code 96372 and the “With or without counseling" section in the table because it is no longer covered.

· Under Billing, Billing for Adult and Non MnVFC Vaccines, we removed CPT Administration Code 96372 in the table because it is no longer covered. We added CPT Administration Codes 96380 and 96381.

December 16, 2024

Individualized Education Program Services

· Record Keeping and Documentation

· We added hyperlinks to the main sections on the top of the page.

· Under Health Services Records, we added new sections for Mental Health Services in Special Education and Children's Therapeutic Services and Supports.

· We updated language for clarity.

December 13, 2024

Provider Basics
Billing Policy Overview

· Payment Methodology - Non-Hospital

· Under the Legislative Changes Related to Rates heading, we updated 2024 and 2025 information.

· Under the Air Ambulance Transportation heading, we removed the Ambulance and Non-Emergency Transportation Proration Schedule.

· We deleted the Pharmacy subsection because that information was obsolete.

Individualized Education Program Services

· Assistive Technology (AT) Devices – We added hyperlinks to the main sections on the top of the page.

Mental Health Services

· Psychotherapy – Under the Authorization heading, we updated to explain providers do not have to submit authorization requests for Psychotherapy services until further notice.

December 12, 2024

Equipment and Supplies

· Spirometers – We updated this manual section for clarity. There are no changes in policy.

December 11, 2024

Provider Basics
Provider Requirements

· Provider Screening Requirements – We updated the new application fee that goes into effect January 1, 2025, that was provided to us by the Centers for Medicare & Medicaid Services.

December 6, 2024

Equipment and Supplies

· Urological and Bowel Supplies – In both the Excess Quantities of Intermittent Catheters subsection under the Authorization heading and the Authorization thresholds for urological supplies table, we clarified that up to 300 units of intermittent catheters with insertion supplies (HCPCS 4353) per month are allowed before authorization is required.

Moving Home Minnesota

Moving Home Minnesota Demonstration and Supplemental Services Table –

December 3, 2024

Dental Services

· Dental Benefits – Under Covered Services, Adjunctive General Services, we removed "and sedation is not used" as part of the service limits for CDT Code D9920 behavior management.

Provider Basics
Provider Requirements

· Access Services – Under Eligible Members, we removed Program HH HIV/AIDS from the table because this program does not cover sign or spoken language interpreter services.

December 2, 2024

Financial Management Services

· Financial Management Services (FMS) – This is a new manual page we created for financial management services providers regarding eligible providers, eligible members, covered and noncovered services and billing.

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November 27, 2024

Dental Services

· Dental Authorization Requirement Tables – Under Restorative, we added CDT D2710 to the table.

November 25, 2024

Enroll with MHCP

· Early Intensive Developmental and Behavioral Intervention (EIDBI) Provider Enrollment Criteria and Forms

· In the Requirements and additional information table under How to Enroll as an EIDBI Provider Agency, we added affiliation and licensing information for DHS-7120B and affiliation information in the qualified supervising professionals section.

· Under the Comprehensive Multi-Disciplinary Evaluation (CMDE) services or qualified supervising professional (QSP) providers heading, we updated the proof required to be submitted for CMDE and QSP providers.

Equipment and Supplies

· Robotic Arms

· Under the Covered Services heading, we added clarifying information about activities of daily living and instrumental activities of daily living.

· Under the Authorization heading, we explain a face-to-face evaluation by a physical or occupational therapist must be documented and the provider must train the member on the use of equipment. Additionally, we've updated to state a three-month trial period is required before requesting a purchase for robotic arms.

· Under Billing, we explained the warranty period, rental reimbursement, and provider responsibility when adding a robotic arm to an existing mobility device.

Hospice Services

· Hospice Services

· Under the Election of Hospice heading, Hospice Transaction Form, we added language to emphasize the importance of submitting the MHCP Hospice Transaction Form (DHS-2868) quickly to have hospice spans entered and avoid billing issues.

· Under the Election of Hospice heading, we added a Pediatric Residential Hospice section.

· Under the Billing heading, we added a Pediatric Residential Hospice Facility Billing section.

November 21, 2024

Enroll with MHCP

· Community First Services and Supports (CFSS) Provider Agency Enrollment Criteria & Forms – We added clarifying language for the amount that a surety bond needs to be for compliance.

Equipment and Supplies

· Equipment and Supplies – In the MHCP-acceptable miscellaneous HCPCS codes table under the Miscellaneous Codes heading under Covered Services, we clarified prior authorization requirements for Procedure Codes A4335 and A4421.

Provider Basics

· Health Care Programs and Services – We revised the Minnesota Health Care Programs table with Major Program information for MinnnesotaCare.

November 14, 2024

Provider Basics
Provider Requirements

· Provider Screening Requirements – We added information in the Revalidation Schedule section in the 2024 Initial Revalidation Date table to provide details about revalidation due dates on revalidation letters compared to revalidation due dates that appear in the MPSE portal.

November 13, 2024

Early Intensive Developmental and Behavioral Intervention

· Early Intensive Developmental and Behavioral Intervention (EIDBI) billing grid – In the Person or Service Limits column, we updated the limit of 6 hours per day to a limit of 8 hours per day for CPT code 0373T for all professional and provider levels.

Equipment and Supplies

· Airway Clearance Devices – Under the Noncovered Services heading, we added lung expansion airway clearance devices.

Immunizations and Vaccinations

· Immunization and Vaccine Benefits Codes for Adults – Under Seasonal Respiratory Illness Vaccines, we added CPT Codes 90656, 90657, 90658, 90660 and 90661. We removed CPT Codes 90672, 90682, 90686 and 90688 because coverage ended.

November 12, 2024

Personal Care Assistance Services

· Personal Care Assistant (PCA ) Services

· In the Overview section, we updated content to reflect that the Minnesota Department of Human Services implemented Community First Services and Supports (CFSS) on Oct. 1, 2024.

· In the Billing, Documentation Requirements section, we added a hyperlink to CFSS Assessment (DHS-6893A) (PDF) which replaces the Supplemental PCA Assessment and Service Plan (DHS-3428D). We also added a hyperlink to Home Care Shared Services Agreement (HCN, PCA or CFSS) (DHS-6893E) (PDF) which replaces Home Care Shared Services Agreements (DHS 5899).

· In the Billing, Submitting PCA Claims section, we clarified when the U2 modifier needs to be used for services. We also added the U2 modifier to the table of HCPCS codes and modifiers for reimbursement of PCA services.

November 7, 2024

Immunizations and Vaccinations

· Immunization and Vaccine Benefits Codes for Children

· Under Seasonal Respiratory Illness Vaccines, we added CPT Codes 90656, 90657, 90658, 90660 and 90661. We removed CPT Codes 90672, 90686, 90687 and 90688. We also updated the hyperlink for the TABLE. Influenza vaccines — United States, 2024–25 influenza season.

· Under Vaccines and Toxoids Available Through MnVFC, we added CPT Code 90678.

· Under Vaccines and Toxoids Not Available Through MnVFC, we removed CPT Codes 90656, 90657 and 90658.

November 6, 2024

Equipment and Supplies

· Incontinence Products – Under the Covered Services heading, we added transcutaneous tibial nerve stimulators and supplies (HCPCS Codes E0736 and A4545) and devices for transvaginal mechanotherapy (HCPCS Codes E0715 and E0716) as covered services.

November 4, 2024

Pharmacy Services

· Pharmacy Services – Effective Nov. 4, 2024, outpatient pharmacy services claims processing and related pharmacy benefit functions transitioned from the Minnesota Department of Human Services to Prime Therapeutics. This impacts only the fee-for-service outpatient pharmacy benefit. Managed care organizations will continue to provide outpatient pharmacy benefits for members enrolled in their plans.

· Under Overview, we added information about outpatient pharmacy claims processing and related pharmacy benefit functions transitioning to Prime Therapeutics effective Nov. 4, 2024.

· Under Overview, Key Points, How to Determine Drug Coverage, we updated the National Drug Code search site hyperlink to its new location on the Minnesota Medical Assistance Portal (hosted by Prime Therapeutics).

· Under Overview, Key Points, Payment for Prescribed Drugs, we updated content to refer to the Prime Therapeutics Provider Manual for more information.

· Under Covered Services, Covered Drugs, we removed the Drugs requiring a diagnosis code hyperlink. We updated the Preferred Drug List hyperlink to its new location on the Minnesota Medical Assistance Portal (hosted by Prime Therapeutics).

· Under Covered Services, Pharmacist Administered Immunizations and Vaccines, we updated content and clarified language.

· Under Covered Services, Pharmacist Prescribing – OTC Medications, we updated the National Drug Code search site hyperlink to its new location on the Minnesota Medical Assistance Portal (hosted by Prime Therapeutics).

· Under Covered Services, Pharmacy Service Limitations, we updated content to refer to the Prime Therapeutics Provider Manual for more information.

· Under Covered Services, Specialty Pharmaceutical Reimbursement, we updated the Specialty Drug List hyperlink to its new location on the Minnesota Medical Assistance Portal (hosted by Prime Therapeutics).

· Under Noncovered Services, Drugs and Costs, we updated content to refer to the Prime Therapeutics Provider Manual for more information.

· Under Authorization and Limitation Requirements, we updated content to refer to the Prime Therapeutics Provider Manual for more information and clarified language for all sections.

· Under Billing, MN–ITS, we removed the hyperlink to the MN–ITS User Guide for Pharmacy.

· Under Billing, we updated content to refer to the Prime Therapeutics Provider Manual for more information and clarified language for the Online Claims Screening (ProDUR), Medical Supplies and Equipment and Prescribing Provider NPI Numbers sections.

· Under Billing, we removed the Point of Sale, Billing Coordination of Benefits and Drugs Requiring a Diagnosis, Reversal of Claims sections.

· Under Definitions, we removed the Dispensing Fee definition.

· We updated language throughout for clarity.

· 340B Drug Pricing Program:

· Under Billing, we clarified that changes to carve-in or carve-out services must first be reflected in the HRSA Medicaid Exclusion File and your provider enrollment record. We also added a hyperlink to the Prime Therapeutics Provider Manual.

· Under Billing, Pharmacy Claims Reimbursement, we updated content to refer to the Prime Therapeutics Provider Manual for more information.

· We updated language for clarity.

· Note: Effective Nov. 4, 2024, outpatient pharmacy services claims processing and related pharmacy benefit functions transitioned from the Minnesota Department of Human Services to Prime Therapeutics. This impacts only the fee-for-service outpatient pharmacy benefit. Managed care organizations will continue to provide outpatient pharmacy benefits for members enrolled in their plans.

Provider Basics

· Drug Authorizations – We updated all content and clarified language to reflect the new guidelines and processes because of the transition to Prime Therapeutics.

· Effective Nov. 4, 2024, outpatient pharmacy services claims processing and related pharmacy benefit functions transitioned from the Minnesota Department of Human Services to Prime Therapeutics. This impacts only the fee-for-service outpatient pharmacy benefit. Managed care organizations will continue to provide outpatient pharmacy benefits for members enrolled in their plans.

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October 28, 2024

Nursing Facilities

· Nursing Facilities – We added the following two sections within the "Medicare and Other Insurance" section:

· Spenddown Refund Requests

· Prohibited Practices

October 18, 2024

Enroll with MHCP

· Community First Services and Supports (CFSS) Provider Agency Enrollment Criteria & Forms – We added the section Adding CFSS Services to an Active Personal Care Provider Organization Not Due for Revalidation.

Nonemergency Medical Transportation (NEMT) Services

· Medical Transportation Management - Minnesota Nonemergency Transportation (MTM-MNET), SmartLink and Local County or Tribal Agency Nonemergency Medical Transportation (NEMT) Services Claim, Service and Rate Information

· Under MTM-MNET, SmartLink and Local County or Tribal Agency-Administered Transportation Personal Mileage Codes, Modifiers and Payment Rates, we updated mileage rates to reflect the Oct. 1, 2024, fuel adjuster.

· Under Personal and Volunteer Driver Mileage, we updated mileage rates to reflect the Oct. 1, 2024, fuel adjuster.

· We also removed the P**** for proration because it no longer applies.

· State-Administered Transportation Procedure Codes, Modifiers and Payment Rates

· Under Transportation Procedure Codes, Modifiers and Payment Rates, we updated mileage rates to reflect the Oct. 1, 2024, fuel adjuster.

· We also removed ***P Proration applies to two or more riders picked up at the same point of origin/pickup location because it no longer applies.

October 17, 2024

Dental Services

· Dental Benefits

· Clinical Oral Evaluations, we updated Service Limits for CDT Code D0120 and CDT Code D0150.

· Diagnostic Imaging, we updated Service Limits for CDT Code D0210. We added CDT Code D0230 in the same row with CDT Code D0220; and updated the Service Limits. We listed CDT Codes D0240, D0250 and D0277, which were previously listed, in their own rows. We updated the Service Limits for CDT Codes D0330 and 0340. We added CDT Codes D0364-0368 for cone beam CT capture and interpretation. We updated the Service Limits for CDT Codes D0372, D0373 and D0374.

· Preventive, we updated Service Limits for CDT Code D1110.

· Restorative, we updated Service Limits for CDT Codes D2140-D2161, D2330-D2394 and D2976.

· Periodontics, we updated Service Limits for CDT Code D4355.

· Adjunctive General Services, we added CDT Code D9311 for medical consultation. We updated Service Limits for CDT Code D9410.

Equipment and Supplies

· Airway Clearance Devices – Under the Noncovered Services heading, we removed the limitation for members with known cardiac conditions for high-frequency chest wall oscillation air-pulse generator systems.

October 15, 2024

Individualized Education Program (IEP)

· Individualized Education Program (IEP) Services

· We updated the Overview to reflect eligible children requirements include 22 years old or those who have not graduated from the 12th grade.

· We removed the table format for clarity.

· We removed the hyperlinks under the main sections for clarity.

· We removed the Mental Health CTSS Definitions and Acronyms hyperlink.

· We changed the section title “Mental Health Services" to “Children's Therapeutic Services and Supports IEP Services Provided in School"

· We added a hyperlink to the new Mental Health Services in Special Education MHCP Provider Manual section.

· Under Legal References, we added Minnesota Statutes, 245I.10

· Billing and Authorization Requirements

· We added hyperlinks to the main sections on the top of the page.

· Under Billing Requirements; IEP Place of Service, Procedure Codes, Modifiers and Units; IEP Evaluation and Reevaluation, we added Evaluation to the title of the Mental Health service which was already listed.

· Under Billing Requirements; IEP Place of Service, Procedure Codes, Modifiers and Units; Health-related services coding schemes, we deleted the Mental Health service and renamed it Children's Therapeutic Services and Supports (CTSS) services: IEP or IFSP services provided in schools. We also added billing information for Mental Health Services in Special Education (MH-SPED) using procedure code T1018 with both the U4 and TM modifier, 1 unit per day.

· We updated language for clarity.

· Children’s Therapeutic Services and Supports (CTSS) IEP Services Provided in School

· We changed the title to Children's Therapeutic Services and Supports (CTSS) IEP Services Provided in School.

· We added hyperlinks to the main sections at the top of the page.

· We changed the section title to Eligible Members from Eligible Children.

· Under Covered Services, we added more information about CTSS services. We also added content about covered evaluations, reevaluations and assessments for IEP or IFSP.

· We changed the section title to Billing from Billing for CTSS Services.

· We updated language for clarity throughout including in the Overview, Covered Services and Billing sections.

· Mental Health Services in Special Education (MH-SPED) (School Social Work Services) – We added a new section for mental health services in special education (MH-SPED).

October 10, 2024

Enroll with MHCP

· Substance Use Disorder (SUD) Services Enrollment Criteria and Forms

· We added a hyperlink to the Recovery Community Organization enrollment and criteria webpage.

· We included information throughout the webpage on how to enroll online using the MPSE Portal or via fax.

· Under the Service Rate Enhancements heading, we clarified service rate enhancements for programs that serve parents with children, medical services, or services to individuals with co-occurring mental health and substance use disorder are approved through the DHS Licensing Division.

· Under the How to Enroll as a Licensed Professional in Private Practice to provide SUD services heading, we added enrollment information.

· Under the 1115 Substance Use Disorder (SUD) System Reform Demonstration, we added ASAM information and clarification.

October 9, 2024

Mental Health Services

· Children's Mental Health Residential Treatment

· Under the Overview heading, we added information for children and youth entering care through the 3rd Path/Children’s Mental Health Residential Services.

· Under Billing, we added information about 3rd Path room and board billing.

October 2, 2024

Equipment and Supplies

· Nutritional Products and Related Supplies – Under the Covered Services heading, we added an Electrolyte-Containing Fluids section as MHCP now covers electrolyte-containing fluid HCPCS codes B4102 and B4103.

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September 30, 2024

Equipment and Supplies

· Incontinence Products – We replaced "per month" to "per calendar month" when referring to unit quantity limits throughout this manual section.

Hearing Aid Services

· Hearing Aid Services

· Under Covered Services, we added chargers for rechargeable hearing aids.

· Under Covered Services, Batteries, we clarified that one charger per year for rechargeable hearing aids is covered if the charger is broken or lost.

September 26, 2024

Community First Services and Supports

· Community First Services and Supports (CFSS) – New manual page for Community First Services and Supports (CFSS) regarding policy and billing.

September 24, 2024

Individualized Education Program (IEP) Services

· MHCP Eligible Children – We added hyperlinks to the main sections on the top of the page.

September 23, 2024

Dental Services

· Dental Benefits – Under Covered Services, Diagnostic, Diagnostic Imaging, we added the description and service limits for CDT Code D0210.

Mental Health Services

· Adult and Children’s Crisis Response Services – Under the Billing heading, we updated both Adult Crisis Service Billing and Child Crisis Service Billing tables with the HT modifiers that should be used when billing.

September 19, 2024

Enroll with MHCP

· Community First Services and Supports (CFSS) Provider Agency Enrollment Criteria & Forms – This is a new manual page explaining the MHCP enrollment process for Community First Services and Supports provider agencies.

· Home Health Enrollment Criteria and Forms – We added a new manual page for home health agency providers.

September 16, 2024

Day Training and Habilitation Day Services

· Day Training and Habilitation (DT&H) – In the Lead Agency Responsibilities section, we removed the 4th bullet "Set payment rates."

Behavioral Health Home Services

· Behavioral Health Home Services – Under the Eligible Members heading, we updated the written consent requirement for the Rights, Responsibilities and Consent (DHS-4797B) to be written or verbal due to a change in statute.

September 11, 2024

Equipment and Supplies

· Diabetic Equipment and Supplies – Under the Overview, Point of Sale Testing Supply program heading, we changed the HCPCS code for blood glucose test strips to A4253.

September 5, 2024

Provider Basics
Provider Requirements

· Provider Screening Requirements – We updated the September and October Revalidation table.

Provider Basics
Billing Policy

· Payment Methodology - Non-Hospital – Under Rate Variations and Legislative Changes, Legislative Changes Related to Rates, we updated text to reflect end dates for dental increases that have ended.

September 4, 2024

Substance Use Disorder Services

· Substance Use Disorder (SUD) Services

· Under the Billing, Authorization heading, we clarified information for H2035 and H2035 HQ.

· Under the Billing, Billable Units and Time Requirements, Nonresidential (outpatient) service heading, we provided an example and additional clarification for nonresidential units of services.

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August 30, 2024

Personal Care Assistant (PCA )

· Personal Care Assistant (PCA )

· In the Overview section, we added information about Community First Services and Supports (CFSS).

· In the Assessment for PCA Services section, we added information about Minnesota Restricted Recipient Program.

· In the Eligible Members section, we changed the language for major program LL to under 19.

· In the Covered Services section, we added information about PCA driving time.

· In the Documentation Requirements section, we added information on Electronic Visit Verification (EVV) and a link to the eDocs DHS-5899 for Home Care Shared Service Agreements.

· In the Submitting PCA Claims section, we clarified language for enhanced rate.

· Revalidation for PCA agencies will be revalidated every three years.

August 29, 2024

Dental Services

· Allied Oral Health Professional and Allied Oral Health Professional Group Enrollment Criteria and Forms

· We changed the page title Allied Oral Health Professional and Allied Oral Health Professional Group Enrollment Criteria and Forms.

· We updated references of Dental Hygienist Group to Allied Oral Professional Group.

· We added requirements for Allied Oral Health Professional – Individual.

· We updated requirements for enrollment, and updated instructions for enrollment using the Minnesota Provider Screening and Enrollment portal.

Elderly Waiver (EW) and Alternative Care (AC)

· Elderly Waiver (EW) and Alternative Care (AC) Program – We updated the information in the Elderly Waiver Customized Living Services Rate Adjustment section.

Enroll with MHCP

· Enrollment with Minnesota Health Care Programs (MHCP)

· Changed the name of Child and Teen Checkups Clinic to Child and Teen Checkup Clinic

· Changed the name of Children's Residential Treatment to Children's Residential Treatment Facility

· Changed Doula to Doula Entity

· Added (HCBS) to Home and Community-Based Services to better match the MPSE Portal.

· Changed Individualized Education Program to Individual Education Program

· Changed PCA Provider Agency to Personal Care Provider Organization (PCPO)

· Changed Public Health Nursing Clinic to Public Health Nursing Organization

· Changed Rehabilitation Billing Entity to Rehabilitation Group

· Changed Renal Dialysis Facility to Renal Dialysis Center

· Changed Acupuncture to Acupuncturist

· Changed Dentist and Dental Group to Dentist

· Changed Pharmacy and Pharmacist to Pharmacist

· Changed Physician and Physician Clinic to Physician

· Changed Registered Dietician or Registered Nutritionist to Registered Dietician or Licensed Nutritionist

· Added Dental Group to the Eligible Provider List for Organizations

· Added Pharmacy to the Eligible Provider List for Organizations

· Added Physician Clinic to the Eligible Provider List for Organizations

· Added Allied Oral Health Professional Group

· Added Allied Oral Health Professional

August 28, 2024

Equipment and Supplies

· Nutritional Products and Related Supplies – Under the Enteral Nutrition Coverage Criteria heading, In-line cartridge containing digestive enzymes Code: B4105, we added fat malabsorption as an eligible diagnosis. Coverage is indicated for use for members age 2 and older who require the delivery of absorbable fatty acids and monoglycerides.

August 20, 2024

Dental Services

· Dental Benefits – Under Covered Services, Restorative, we updated CDT Code D2991 Service Limits to once per tooth number per 180 days.

August 19, 2024

Moving Home Minnesota

· Moving Home Minnesota (MHM)

· We clarified Moving Home Minnesota (MHM) qualified instructions and qualified community residences.

· We added information about Substance Use Disorder (SUD) and the programs and people who are eligible to receive MHM services.

· We clarified the Eligible Members section.

· We updated the Member Enrollment section and links to the MHM Program Manual pages and forms.

· We clarified the Covered Services section.

· We added information in the Denied or Suspended Claims section related to MHM.

· We updated the information about Targeted Case Management (TCM), as people receiving TCM (except RSC-TCM) are now allowed to access MHM Services at the same time.

Rehabilitative Services

· Rehabilitative Service Codes for OT, PT and Speech-Language Pathology – In the Occupational Therapy, Physical Therapy and Speech-Language table, we added G2250 and G2251 as billable HCPCS codes by Speech Language Pathologists.

August 15, 2024

Enroll with MHCP

· Direct Support Worker (DSW), Individual Enrollment Criteria and Forms

· We updated this section with links to the step-by-step guide and video module with instructions to enroll for direct support workers, Community Directed Community Supports, and Consumer Support Grant workers.

Equipment and Supplies

· Mobility Devices

· Under the Covered Services heading, Wheelchair Options and Accessories, we revised criteria for the power tilt function to allow authorization requests for manual wheelchair users.

· Under the Billing heading, we updated information for the KU modifier to declare that Minnesota Health Care Programs follows the Centers for Medicare & Medicaid Services fee schedule.

August 13, 2024

Provider Basics
Provider Requirements

· Provider Screening Requirements – Added upcoming revalidation dates in the Revalidation Schedule section.

· Past Revalidation Schedule – We moved past revalidation dates to this section of the manual.

August 2, 2024

Mental Health

· Youth Assertive Community Treatment (Youth ACT)/Intensive Rehabilitative Mental Health Services (IRMHS) – Under the Billing heading, we added a link to the 2024 IRMHS rates approved by the Minnesota Department of Human Services Behavioral Health Division.

August 1, 2024

Behavioral Health Home Services

· Behavioral Health Home Services – Under Noncovered Services, we removed Moving Home Minnesota from the list of duplicatve services.

Mental Health Services

· Children's Therapeutic Services and Supports (CTSS)

· We updated CTSS directions for community and school-based providers to gain certification, recertification and provider responsibilities.

· We updated CTSS policy language for covered service components and assessments.

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July 22, 2024

Nonemergency Medical Transportation (NEMT) Services

· Local County or Tribal Agency Nonemergency Medical Transportation (NEMT) Transportation Services – Under Enrollment, we clarified the definition for volunteer drivers.

July 17, 2024

Early Intensive Developmental and Behavioral Intervention (EIDBI)

· Early Intensive Developmental and Behavioral Intervention (EIDBI) billing grid – In the Person or Service Limits column for procedure code 0373T, we removed instructions explaining to bill only the total time of one provider and clarified service is based on the face-to-face time of a single provider, even when multiple providers are present.

Enroll with MHCP

· Dental Hygienist Group or Individual Enrollment Criteria and Forms

· We added criteria and forms for dental hygienist individual.

· We updated criteria and forms instructions for dental hygienist group

· Under Revalidation, we updated language for clarity.

July 16, 2024

Provider Basics

· Provider Requirements – We changed the name for SIRS to the Program Integrity Oversight Division (PIOD). We added information to submit tips for suspected fraud or abuse. We revised the Record Keeping Requirements section for clarity.

July 15, 2024

Hearing Aid Services

· Bone-Anchored Hearing Aids (BAHA) – Under Eligible Members, we added age and audiological criteria for nonsurgical BAHA devices.

July 9, 2024

Mental Health Services

· Psychiatric Residential Treatment Facility (PRTF) – Under Provider Responsibilities, Documentation, we clarified diagnostic assessment requirements for the individual plan of care.

July 5, 2024

Equipment and Supplies

· Positioning Equipment – Under Noncovered Services, we added a provision stating positioning equipment requested for behavioral health reasons is not covered by MHCP.

· Robotic Arms

· Under Eligible Members, we added arthrogryposis to the list of potential diagnoses.

· Under Authorization, we added a letter of medical necessity must be included in authorization requests, and we updated the review process.

· Under Billing, we added a modifier for rentals and rental documentation requirements.

Nonemergency Medical Transportation (NEMT) Services

· Nonemergency Medical Transportation (NEMT) Services – We added a new Nonemergency Medical Transportation (NEMT) Services page. This page includes hyperlinks to all the NEMT services sections in the MHCP Provider Manual.

July 1, 2024

Transportation Services

· Medical Transportation Management - Minnesota Nonemergency Transportation (MTM-MNET), SmartLink and Local County or Tribal Agency Nonemergency Medical Transportation (NEMT) Services Claim, Service and Rate Information – We updates rates for July 1, 2024.

· State-Administered Transportation Procedure Codes, Modifiers and Payment Rates – We updated rates for July 1, 2024.

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June 28, 2024

Provider Basics

· Billing Policy Overview – Under Reconsideration of a Claim, we updated text in the second bullet under No. 2 to state "Meets the MHCP Attachment Criteria to submit an Electronic claims attachment (sent by the end of the next business day of the electronic claim) that includes medical necessity or other forms of documentation that supports the claim".

June 27, 2024

Member Evidence of Coverage

· MHCP Member Evidence of Coverage – Under Dental Services we updated the language. No change to policy or benefits.

June 21, 2024

Enroll with MHCP

· Rehabilitation Group Enrollment Criteria and Forms

· We changed the title of this section from Rehabilitation Billing Entity to Rehabilitation Group.

· We added registered dietician or licensed nutritionist as eligible providers for affiliation to this provider type.

· We added links to the enrollment forms and criteria pages for each of the available provider types Rehabilitation Group can affiliate to.

· Under Revalidation, we added revalidation information and instructions.

June 20, 2024

Early Intensive Developmental and Behavioral Intervention

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

· In the Person or Service Limits column for procedure code 97151, we changed to state One CMDE is allowed per calendar year without a service agreement (maximum of 80 units per calendar year).

· In the Person or Service Limits column for procedure code 0373T, we removed instructions explaining to bill only the total time of one provider.

June 18, 2024

Enroll with MHCP

· Registered Dietician or Licensed Nutritionist Enrollment Criteria and Forms – Changed title of section from "Registered Dietician" to "Licensed Dietician".

Provider Basics
Provider Requirements

· Provider Screening Requirements – In the Revalidation Schedule section, we added the revalidation dates and provider types for June and July 2024.

June 17, 2024

Substance Use Disorder Services

· Substance Use Disorder (SUD) Services – Under the Authorization section heading, we clarified the rolling seven-day time span and included an example.

Provider Basics
Provider Requirements

· Risk Levels and Enrollment Verification Requirements – We updated the provider types and added Doulas, Recuperative Care, and Consumer Directed Community Supports and Community First Services and Supports individual providers.

June 12, 2024

Enroll with MHCP

· Doula Enrollment Criteria and Forms

· Under How to Enroll Doula-Individual, we added information about the Minnesota Department of Health Doula Registry requirement.

· Under How to Enroll Doula-Organization, we added that an organization must have a federal employer identification number.

· We added a new Provider Basics training section

Community Health Worker (CHW)

· Community Health Worker (CHW) – Under Billing, G0022, we added that E& M visits cannot be a low-level E&M visit. We also added that only one practitioner can bill for community health integration services per month.

June 10, 2024

Dental Services

· Dental Benefits – Under Covered Services, Diagnostic, Clinical Oral Evaluations, we added CDT code D1120 to Service Limits for D0140 limited exam.

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May 30, 2024

Rehabilitation Services

· Rehabilitative Service Codes for OT, PT and Speech-Language Pathology – In the Evaluative, Therapeutic and Rehabilitative table, we clarified modifiers GO and GN are the only modifiers allowed for billing for codes 97129 and 97130.

May 23, 2024

Equipment and Supplies

· Respiratory Equipment – Under the Billing heading, we added that modifier 76 is required on authorizations for a second ventilator.

Program HH (HIV/AIDS) Services

· Program HH (HIV/AIDS) Services

· Under all Dental Benefit sections, we replaced the Children and Pregnant Women benefit set links with links to Dental Benefits. MHCP dental benefits no longer have age or pregnancy status as qualifiers effective Jan. 1, 2024.

· Under Dental Benefit, Dental Benefit Authorization Requirements, we added authorization criteria information for members with third-party liability or Medicare coverage.

· Under Dental Benefit, Dental Benefit Billing, we added more information on covered services.

· Under Dental Benefit, Denied benefit claim questions, we removed the Program HH Customer Care email address.

Enroll with MHCP

· Home Health Enrollment Criteria and Forms – We added a new manual page for home health agency providers.

Hearing Aid Services

· Hearing Aid Services Codes – We updated Code V5014 to exclude hearing aid remakes, recasing and replating.

May 22, 2024

Transportation Services

· Medical Transportation Management - Minnesota Nonemergency Transportation (MTM-MNET), SmartLink and Local County or Tribal Agency Nonemergency Medical Transportation (NEMT) Services Claim, Service and Rate Information – We updated language to clarify that NEMT services providers cannot bill MHCP directly for Mode 3 - Unassisted transport (curb-to- curb) and Mode 4 - Assisted transport (door-to-door and door-through-door) services; and must contract with one of the following organizations for billing and reimbursement.

· Medical Transportation Management – Minnesota Nonemergency Transportation (MTM-MNET)

· SmartLink

· Local county or tribal agency

May 20, 2024

Enroll with MHCP

· Transportation Driver Enrollment Criteria and Forms – We added definitions for publicly operated transit systems, volunteer drivers and not-for-hire vehicles which are exempt from enrolling drivers along with ambulance services.

May 17, 2024

Transportation Services

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

· Under Eligible Providers, Enrollment, we added definitions for publicly operated transit systems, volunteer drivers and not-for-hire vehicles which are exempt from enrolling drivers along with ambulance services.

· Under Covered Services, Nursing Facility Members Approved for State-Administered NEMT Statewide, we removed the link to State-Administered Nonemergency Medical Transportation (NEMT) Trip Sheet (DHS 7047) (PDF) because it is no longer required.

· We replaced KEPRO with medical review agent.

May 16, 2024

Dental Services

· Dental Benefits – Under Covered Services, Prosthodontics, we removed CDT codes D5640 and D5650 from Service Limits for adjustments and repairs to complete dentures. Additionally, we removed D5520 from Service Limits for Repairs to partial dentures.

May 8, 2024

Equipment and Supplies

· Respiratory Equipment – Under the Authorization heading, we updated to explain that authorization is required for a second ventilator.

May 2, 2024

Program HH (HIV/AIDS) Services

· Program HH Dental Authorization Requirement Chart

· We renamed the Authorization Requirements Table to Children and Pregnant Women link to Dental Authorization Requirement Tables. This change reflects that dental benefits have no age or pregnancy status as qualifiers effective Jan. 1, 2024.

· Additionally, we aligned the prior authorizations criteria for services covered under Program HH with those covered under the main Dental Benefit set.

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April 26, 2024

Recuperative Care

· Recuperative Care

· We added a note about the temporary hold on recuperative care provider enrollment.

· Under Overview, we added information about referrals.

· Under Eligible Providers, we added information and clarified language about facility providers and health services providers. Additionally, we added links to the new Recuperative Care Enrollment Criteria and Forms manual page.

· Under Covered Services, we added information about only providing services within a facility's or provider's scope of practice. Additionally, we added information about how a physical condition is needed to receive recuperative care services.

· Under Authorization, we added links to Recuperative Care Extended Stay Request (DHS-8513) (PDF). We also added information about discharge locations.

· Under Billing, we added information about when the recuperative care facility rate is reimbursed and the option to receive only the recuperative care health services rate.

· Under Billing, Recuperative Care Health Services Claim (Professional Claim), we removed condition code 17. We clarified who can render and bill health services for recuperative care services.

· Under Billing, Recuperative Care Facility Rate, we added the daily room and board rate.

· Under Billing, Recuperative Care Facility Claim, we updated the billing format to 837I.

· Under Managed Care Members, we updated language for clarity.

Reproductive Health/OB-GYN

· Obstetric Services

· Under Covered Services, Lactation, we added a link to the new Breast Pumps manual page.

· Under Billing, we added links to Provider Requirements and 837P MN–ITS billing instructions.

April 25, 2024

Hearing Aid Services

· Bone-Anchored Hearing Aids (BAHA)

· We updated the Dispensing Fee section title to Dispensing Fee for Nonsurgical or Non Osseointegrated.

· Under Billing, we added information about referring to the MHCP fee schedule for the fitting and follow-up of surgical/osseointegrated bone anchored devices.

Transportation Services

· Local County or Tribal Agency Nonemergency Medical Transportation (NEMT) Transportation Services – Under Overview, Local Agency NEMT Coordination, we added SmartLink information for Carver and Scott counties.

April 19, 2024

Dental Services

· Dental Authorization Requirement Tables – Under Restorative, we removed CDT codes D2930, D2931, D2932 and D2933 because they do not require prior authorization.

· Dental Benefits – Under Restorative, we updated the Service Limits for CDT codes D2930-2934 and removed that authorization is required. We also added Service Limit information for CDT code D2991.

Reproductive Health/OB-GYN

· Doula Services

· Under Covered Services, we updated that MHCP will cover up to 18 visits without prior authorization effective May 1, 2024. We also updated language for clarity.

· Under Billing, we replaced National Provider Identifier with provider identification number.

April 17, 2024

Equipment and Supplies

· Breast Pumps – We have added a new section of the MHCP Provider Manual for breast pumps.

· Hospital Beds – Under the Typically Noncovered Services heading, we added technology hub.

· Seizure Detection Devices – We clarified language on FDA requirements for seizure detection devices under the Overview and Noncovered Services headings.

Mental Health Services

· Mental Health Services – We have reformatted this section of the manual to serve as a landing webpage for Mental Health. Links to services falling under Mental Health are included under Covered Services in this manual section and have been removed from the left navigation on the MHCP Provider Manual.

April 12, 2024

Transportation Services

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

· We updated the section header "Transportation Personal Mileage Codes, Modifiers and Payment Rates" to "Local County or Tribal Agency–Administered Transportation Personal Mileage Codes, Modifiers and Payment Rates." Additionally, we updated mileage reimbursement with the new April 1, 2024, fuel adjuster in this section.

· We clarified language for rural urban commuting area base and mileage adjustments.

· We added a Legal References section.

April 11, 2024

Provider Basics

· Billing Policy Overview

· We changed the Remittance Advice section to clarify that MHCP-enrolled providers receive their RAs in one of the following formats:

· Readable PDF file placed in the provider's MN–ITS mailbox

· X12 835 batch file placed in the provider's MN–ITS mailbox *Note for X12 835 batch files, software is required to translate the batch file. DHS does not have the software to translate the file for you.

· Use the Electronic Remittance Advice Request (DHS-4087) (PDF) to add or remove an electronic RA on a provider's MN–ITS account, to change the format you will receive your RA, or remove an RA affiliation with a billing organization.

· We also added a link to the How to Read Your Remittance Advice on-demand video.

Waiver and Alternative Care (AC) Program

· Waiver and Alternative Care (AC) Program – We added a Waiver and Alternative Care (AC) Program manual section that links to each specific provider manual section for better organization of the MHCP Provider Manual.

April 8, 2024

Transportation Services

· State-Administered Transportation Procedure Codes, Modifiers and Payment Rates

· Under Transportation Procedure Codes, Modifiers and Payment Rates, we updated mileage reimbursement with the new April 1, 2024, fuel adjuster.

· We clarified language for rural urban commuting area base and mileage adjustments.

April 4, 2024

Dental Services

· Dental Benefits – Under, Prosthodontics, we clarified language and authorization requirements for CDT codes D5110 - D5140, D5810 and D5811.

Dental Services

· Dental Benefits – Under, Prosthodontics, we clarified language and authorization requirements for CDT codes D5110 - D5140, D5810 and D5811.

· Dental Authorization Requirement Tables

· Under Restorative, we added Dental CDT codes D2930-2934 for a prefabricated crown.

· Under Prosthodontics, we removed content about all prosthodontics having a service limit of one of every three years and initial placement authorizations.

· Under Prosthodontics, we named the Removable Prosthodontics section to Removable Prosthodontics Including Complete and Partial Dentures and clarified language.

· Under Prosthodontics, we renamed the Fixed Prosthodontics section to Fixed Prosthodontics Including Crown and Dental Bridge and clarified language.

HCBS Waiver Services

· HCBS Waiver and AC Training Requirements – Under the HCBS Waiver and AC Provider Training 101 section, we included a list of acceptable proofs of completion.

Physician and Professional Services

· Physician and Professional Services – We removed the link for the Health Care Homes page from the left navigation of the MHCP Provider Manual and added the link to the Physician and Professional Services page.

April 3, 2024

Enroll with MHCP

· Housing Support Supplemental Services Enrollment Criteria and Forms – We added Revalidation and Reporting Changes sections. We also modified and reformatted to be more consistent with other enrollment criteria and forms manual sections.

· Moving Home Minnesota (MHM) Enrollment Criteria and Forms – We updated the page to include Revalidation information for Moving Home Minnesota providers.

Equipment and Supplies

· Mobility Devices – Under Covered Services, Wheelchair Options and Accessories heading, we replaced HCPCS code E2300 Seat elevation feature with E2298 Power seat elevation system due to CMS publishing code updates related to power seating systems. HCPCS code E2300 has been discontinued and replaced by code E2298. Coverage criteria is the same.

Physician and Professional Services

· Physician and Professional Services – Under the Stem Cell Transplant Coverage heading under Transplant Services, we added information about coverage for allogenic stem cell transplants per a Centers for Medicare & Medicaid Services update for mylodysplastic syndromes.

April 2, 2024

Home page

· MHCP Provider Manual Home – Updated the Table of Contents. Moved links to the Authorization Criteria: Cardiac Magnetic Resonance Imaging of the Coronary Arteries and the Coverage Criteria: Computed Tomography Colonography to under Radiology/Diagnostic Services. Removed the link to Laboratory Authorization Code List as it is no longer in use.

Transportation Services

· Protected Transportation Services

· Under Eligible Providers, Protected Transportation Provider Service Requirements, we updated the Minnesota Department of Human Services contact from Bob Ries to Brian Ombongi.

· We updated language for clarity.

Laboratory/Pathology, Radiology & Diagnostic Services

· We deleted the Laboratory, Pathology, Radiology & Diagnostic Services from the left-hand navigation. We created new pages for the Laboratory and Pathology Services and the Radiology/Diagnostic Services that can be found on the left-hand navigation.

Member Evidence of Coverage

· MHCP Member Evidence of Coverage – Under the Housing Stabilization Services heading under Covered Services, Specific health care services, we added information about a new benefit, Moving Expenses.

April 1, 2024

Enroll with MHCP

· Housing Stabilization Services Enrollment Criteria and Forms – In the bullet points under the opening paragraph, we clarified where to find the required training modules.

Reproductive Health/OB-GYN

· Family Planning

· Under Eligible Members, we clarified language.

· We added a new Telehealth Services section.

· Under Billing, we updated that 12 months of contraceptives are now allowed to be dispensed at a time. Additionally, we added links to the MN–ITS 837P Professional User Guide and Equipment and Supplies in the MHCP Provider Manual.

Housing Stabilization Services

· Housing Stabilization Services – We added information about Moving Expenses as a covered service under the Eligible Providers, Covered Services and Billing headings.

____________________________________________________________________

March 26, 2024

Home page

· MHCP Provider Manual Home – We reorganized the content on this page for clarity. We also added additional links under the Resources section and added the Provider Manual Table of Contents section, which are links to the pages in the MHCP Provider Manual.

Provider Basics

· MHCP Provider Manual - Provider Basics – We removed the link to "Enroll with MHCP" and added it to the left-hand navigation. We also removed the link to the "Provider Manual Home" page and added it to the left navigation.

March 20, 2024

Provider Basics
Enroll with MHCP

· Recuperative Care Enrollment Criteria and Forms – We added information that MHCP is temporarily holding on processing enrollment for recuperative care services providers.

Targeted Case Management

· Targeted Case Management – We added a Targeted Case Management (TCM) manual section that links to each specific TCM service provider manual section for better organization of the MHCP Provider Manual.

March 18, 2024

Clinic Services

· Federally Qualified Health Center and Rural Health Clinics – We clarified that the audio-only telehealth service will end July 1, 2025, as part of the face-to-face encounter payment methodology.

Equipment and Supplies

· Robotic Arms – We have created this new Minnesota Health Care Programs (MHCP) Provider Manual section because we now cover robotic arms for MHCP members with heavily restricted use of their upper extremities. Robotic arms require prior authorization and a three-month rental period. The effective date for this update is March 18, 2024.

March 14, 2024

Dental Services

· Dental Benefits

· Under Covered Services, Diagnostic, Clinical Oral Evaluations, we added service limits for CDT D0120.

· Under Covered Services, Restorative, we updated the description for CDT D2710-D2722. Additionally, separated out CDT D2930-2934 from CDT D2710-D2722.

· Under Covered Services, Periodontics, we added service limits for CDT D4341 and D4342.

· Under Covered Services, Prosthodontics, we added service limits for CDT D5110-D5140, D5810 and D5811.

· Under Covered Services, Prosthodontics, we added service limits for CDT D5211-D5226, D5820 and D5821.

March 13, 2024

COVID-19

· Coronavirus (COVID-19) – We added the end date of July 1, 2025, to Federally Qualified Health Center and Rural Health Center for audio-only telehealth services included as part of the face-to-face encounter payment methodology.

Reproductive Health/OB-GYN

· Free-Standing Birth Center Services – We added a new Telehealth Services section.

March 12, 2024

Hearing Aid Services

· Bone-Anchored Hearing Aids (BAHA)

· Under Eligible Members, we added a new Dispensing Fee section with information about MHCP covering dispensing fees for non osseointegrated or non surgical hearing aids.

· Under Billing, we added a new Dispensing Fee Claims section.

Reproductive Health/OB-GYN

· Minnesota Family Planning Program (MFPP)

· Under Contraceptive and Medication Supplies, we updated that 12 months of contraceptives are now allowed to be dispensed at a time.

· We added a Telehealth Services section.

March 7, 2024

Provider Basics
Enroll with MHCP

· Enrollment with Minnesota Health Care Programs (MHCP) – We added "Doula providers (individual and organizational providers)" in the Unique Minnesota Provider (UMPI) section at number 3.

March 6, 2024

Provider Basics

· Billing Organizations/Responsibilities – We added steps for providers to change billing organizations.

Equipment and Supplies

· Orthotics – Under Covered Services, Cranial prostheses, we explained one medical wig per calendar year is covered for members for treatment of medical conditions that result in hair loss. We added this information to this manual section to align with the Medical Supply coverage guide (PDF).

March 5, 2024

Reproductive Health/OB-GYN

· Obstetric Services

· We removed HIV counseling from the page title. HIV counseling is still considered an obstetric service and the policy information remains on the manual page.

· We replaced “at-risk" with “high-risk" to meet best practice language.

· Under Covered Services, we added a new Lactation section.

· We removed the Authorization Requirements and Ambulatory Uterine Monitoring Device sections because it is no longer covered.

· Under Covered Services, Prenatal Screening and Enhanced Services for High-risk Pregnancies, we removed subcutaneous terbutaline pump content because it is no longer covered.

· We updated language for clarity.

March 4, 2024

Provider Basics
Provider Requirements

· Provider Screening Requirements – We added Recuperative Care to the list of MHCP Institutional Providers.

Physician and Professional Services

· Physician and Professional Services – We added the sections Sleep Testing Covered Services and Sleep Testing Noncovered Services.

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February 29, 2024

Provider Basics
Enroll with MHCP

· Targeted Case Management (TCM) Enrollment Criteria and Forms

· We added vulnerable adult/developmental disability to the types of targeted case management services.

· Under Revalidation, we added clarifying information.

· Housing Stabilization Services Enrollment Criteria and Forms

· We reformatted this enrollment criteria and forms webpage to match our other enrollment criteria and forms webpages.

· Under Revalidation, we added clarifying information.

Pharmacy Services

· Pharmacy Services

· Under Covered Services, Pharmacy Service Limitations, we updated that contraceptive drugs can be dispensed in up to 365-day supplies.

· Under Authorization and Limitation Requirements, we updated the MHCP prescription drug PA review agent call center hours to 8 a.m. to 5:30 p.m., Monday through Friday.

February 27, 2024

Reproductive Health/OB-GYN

· Abortion Services

· We added a Telehealth Services section.

· Under Billing, Abortion-Related Services, we updated information to include that pharmacy claims for mifepristone and misoprostol may be billed directly to managed care organizations.

February 23, 2024

Dental Services

· Allied Oral Health Professional (Overview)

· We added section hyperlinks on the top of the page.

· We changed the Eligible Recipients section title to Eligible Members. Under Eligible Members, we renamed the Dental for Children & Pregnant Women link to Dental Benefits. Additionally, we removed the link to the Dental Benefits for Non-Pregnant Adults. MHCP dental benefits no longer have age or pregnancy status as qualifiers effective Jan. 1, 2024.

Provider Basics
Health Care Programs and Services

· MHCP Benefits at-a-glance – In the Minnesota Health Care Programs (MHCP) Benefits at-a-glance table, we updated the listing for Dental for Children & Pregnant Women to Dental Benefits. We also removed the Dental for Non-Pregnant Adults listing. MHCP dental benefits no longer have age or pregnancy status as qualifiers effective Jan. 1, 2024.

Provider Basics
Enroll with MHCP

· Early Intensive Developmental and Behavioral Intervention (EIDBI) Provider Enrollment – We added a section for Background Studies using NETStudy 2.0 and reformatted throughout to clarify enrollment requirements.

Provider Basics

· Authorization

· Under the Review Agents heading, How to submit authorization requests to the medical review agent table, we added information for Substance Use Disorder services for Nonresidential (outpatient) group and individual treatment.

· Under the Review Agents heading, we acknowledged Acentra Health (previously called Kepro) as the medical review agent.

· We added a Substance Use Disorder Request for Nonresidential (outpatient) Group and Individual Treatment section, which includes information about authorization requests for Substance Use Disorder nonresidential (outpatient) group and individual treatment that exceeds six hours per day or 30 hours per week.

Substance Use Disorder (SUD) Services

· Substance Use Disorder (SUD) Services

· Under the Covered Services heading, we added: Comprehensive Assessment (An SUD licensed facility can begin providing services before completion of a comprehensive assessment when the comprehensive assessment is completed in the time frame set forth in Minnesota Statutes 245G.)

· Under the Noncovered Services heading, we added substance use disorder services provided by counties, recovery community organizations, and licensed professionals in private practice before the comprehensive assessment is completed are not covered. unless the comprehensive assessment is conducted before service initiation.

· We updated the Revenue and Procedure Codes table to change service limitations for H2035 and H2035 HQ per guidance and direction of Minnesota Statutes 254B.05, subdivision 5 (h).

· Added Authorization section for SUD authorization requests for Nonresidential (outpatient) group and individual treatment for more than six hours a day or 30 hours a week.

February 16, 2024

· HCBS Waiver Services – Corrected the text from "Providers are responsible for submitting cost reporting data annually" to "All Disability Waiver Rate System (DWRS) provider agencies must report at least once during a 5 year cycle".

February 14, 2024

Community Health Worker (CHW)

· Community Health Worker (CHW) – Under Billing, we added information about procedure codes G0019 and G0022 (community health integration services) that community health workers can bill for when providing services to Medicare members.

February 9, 2024

Provider Basics
Enroll with MHCP

· Licensed Psychologist Enrollment Criteria and Forms

· Under the Online MPSE Portal and Submit Forms via Fax headings, we updated the list of documents required to enroll.

· Under the Neuropsychology Post-Doctoral Sub-Specialty Enrollment heading, we updated the requirements to match statute.

· Under the Revalidation heading, we added information explaining the revalidation process.

February 8, 2024

HCBS Waiver Services

· HCBS Waiver Services – In the Service Authorization section, we added a subsection for Provider Responsibilities with information regarding the Disability Waiver Rate System (DWRS) cost report and a link to the DWRS cost reporting webpage.

Equipment and Supplies

· Equipment and Supplies

· We have added a Noncovered Services heading and section and clarified information under the Typically Noncovered Services heading. There was no change to policy for covered, noncovered and typically noncovered services.

· Under Billing, Billing prior authorization claims and services heading, we clarified policy for billing services that require prior authorization and do not have a fee schedule rate. Pricing documents must be submitted with the claim and with the prior authorization request.

February 7, 2024

Dental Services

· Dental Authorization Requirement Tables

· Under Prosthodontics, we made the following changes.

· Updated the service limit to three years.

· Changed requests for replacement of existing prosthesis to three years.

· Added additional criteria for removable prosthodontics.

· Under Oral and Maxillofacial Surgery, Impacted Teeth, we updated language for clarity.

Laboratory/Pathology, Radiology & Diagnostic Services

· Laboratory/ Pathology Services – Under the Billing heading, Drug Testing, we removed:

· For outpatient pain management or substance abuse settings, presumptive urine drug testing (UDT) may be considered medically necessary for the following:

· Baseline screening at the time treatment is initiated: One time per program entry

· Stabilization phase: Weekly screening for a maximum of four weeks

· Maintenance phase: Screening once every one to three weeks

· We added information to be included in a patient's medical record and revised information about the maximum number of presumptive and definitive UDTs that can be billed and the conditions definitive UDTs are medically necessary.

February 6, 2024

Provider Basics
Provider Requirements

· Excluded Provider Lists

· We updated the name of the Office of Inspector General to "Health and Human Services–Office of Inspector General."

· We updated the Removal from lists section to the following:

· An individual provider or entity must submit a written request to the DHS Program Integrity Oversight Division to be removed from the state exclusion list. The request must include their full name, date of birth, current address and contact information. The written request can be sent to oig.investigations.dhs@state.mn.us or mailed to PO Box 64982, St. Paul, MN 55164, ATTN: Exclusions.

Provider Basics
Billing Policy Overview

· Billing the Member (Recipient) – Under Copays and Family Deductible, we added copay information about emergency room visits for a toothache or other dental condition.

Equipment and Supplies

· Mobility Devices – Under the Billing heading, we clarified the KU modifier can be billed for wheelchair accessories and seat back cushion codes listed in Attachment A of CR 12453 when provided in connection with Group 3 power wheelchairs, complex rehabilitative manual wheelchairs, and certain other manual wheelchairs described by HCPCS codes E1161, E1231-E1238, K0005 and K0008.

February 5, 2024

Provider Basics
Enroll with MHCP

· Recuperative Care Enrollment Criteria and Forms – We added a new manual page for recuperative care providers.

February 2, 2024

Mental Health Services

· Psychiatric Residential Treatment Facility (PRTF) – Under the Overview heading, we clarified Psychiatric Residential Treatment Facilities (PRTF) are not considered foster care placements and children or youth are admitted to a PRTF only after medical necessity is determined.

Housing Stabilization Services

· Housing Stabilization Services – Under the Billing heading, we added Remote Support U4 modifier information.

February 1, 2024

Transportation Services

· Transportation Services - Local County or Tribal Agency Nonemergency Medical Transportation (NEMT) Services Claim, Service, and Rate Information – Under Bus, Paratransit and Air Travel, we added “round-trip" to the Rural Urban Commuting Area (RUCA) Adjustments Add-on section title and under the Transport Mileage RUCA Adjustments section for clarification.

____________________________________________________________________

January 31, 2024

Home Care Services

· Home Care Services – Under Billing, we added information about submitting home care claims. The information explains which type of transaction to submit in MN–ITS and includes the home care services (non-PCA) billing codes chart. The home care (non-PCA) billing codes chart is from the MN–ITS (837I) Institutional Home Care (Non-PCA) Services user guide.

Immunizations and Vaccinations

· Immunizations and Vaccinations

· Under Billing for Child Vaccines

· Under with counseling, CPT administration code 90480, we removed the language “MHCP does not require the use of COVID-19." We also added CPT administration code 96380 (RSV vaccine) for date of service on, or after, Jan. 1, 2024.

· Under without counseling, we added CPT administration code 96381 (RSV vaccine) for date of service on, or after, Jan. 1, 2024.

· Under with or without counseling, CPT administration code 96372, we added the dates of service from July 1, 2023 to Dec. 31, 2023.

· Under Billing for Adult and Non MnVFC Vaccines, CPT administration code 90480, we removed the language "MHCP does not require the use of COVID-19 CPT vaccine codes."

Provider Basics
Enroll with MHCP

· Health Care Case Coordinator Enrollment Criteria and Forms – We added information to this page to make it match our other enrollment pages. We added a section for reporting changes to enrollment, and added the Minnesota Provider Screening and Enrollment (MPSE) portal as an option for enrollment.

· Medical Services Group Enrollment Criteria and Forms – The title of this page was updated from Billing Entity for Physician Group to Medical Services Group.

January 30, 2024

Rehabilitative Services

· Orthotic Procedures – We performed a full review of the L-codes table. There are no new billable codes, we just updated the document.

Dental Services

· Dental Benefits

· Under Covered Services, Preventive, we added the following CDT codes D1310, D1320 and D1321. We clarified service limits for D1330.

· Under Prosthodontics, Service Limits, we updated that initial placement or replacement of a removable prosthesis is now limited to once every three years effective Jan. 1, 2024.

January 26, 2024

Housing Support Supplemental Services

· Housing Support Supplemental Services

· Under the Overview heading, we added that individuals are not eligible for Housing Support Supplemental Services if they receive services through Elderly Waiver or Alternative Care and we updated to the 2024 service rate.

· Under the Billing heading, we clarified that the member's home is the only place of service currently available for Housing Support supplemental services.

Mental Health Services

· Adult Day Treatment

· Under the Eligible Members heading, Admission Criteria, we changed the functional assessment update timeline from 90 to 180 days and added statute language, and removed information stating the level of care must be completed 10 days before discharge. We also clarified requirements for Individual Treatment Plans and reorganized the admission criteria list for clarity.

· Under the Covered Services and Noncovered Services headings, we added service hour requirements and limitations per statute.

· Under the Noncovered Services heading, we removed "Day treatment in the member's home" to avoid confusion with allowed telehealth services.

· Under the Legal References heading, we added Minnesota Statutes, 245I.

Immunizations and Vaccinations

· Immunization and Vaccine Benefits Codes for Adults – Under COVID-19 Vaccines, we updated that commercially purchased COVID-19 vaccines are reimbursable through MHCP effective Sept. 11, 2023.

January 25, 2024

Equipment and Supplies

· Seasonal Affective Disorder (SAD) Lights – Under the Authorization heading, we updated to include seasonal affective disorder as an eligible diagnosis for a therapeutic light box.

January 24, 2024

Hearing Aid Services

· Hearing Aid Services – Under Noncovered Items and Services, we added hearing mold color upgrades.

Equipment and Supplies

· Mobility Devices – Under the Billing heading, we added information explaining the KU modifier can be billed for manual wheelchair accessories and seat and back cushion codes.

January 23, 2024

Provider Basics
Enroll with MHCP

· PCA Provider Agency Enrollment Criteria and Forms

· In the PCPO and PCA Choice Enrollment section, we added information for enrolling using the Minnesota Provider Screening and Enrollment (MPSE) portal.

· We also updated the Revalidation and Reporting Changes sections for clarity.

January 22, 2024

Immunizations and Vaccinations

· Immunization and Vaccine Benefits Codes for Adults – We removed the language "Minnesota Health Care Programs (MHCP) providers can bill MHCP for vaccines (excluding COVID-19 vaccines) listed in the tables and for vaccine administration. Note, MHCP only reimburses for the administration of the COVID-19 vaccines."

Rehabilitation Services

· Rehabilitative Service Codes for OT, PT and Speech-Language Pathology –In the Occupational Therapy, Physical Therapy and Speech-Language table, we added CPT codes 97550, 97551, 97552 for rehabilitative services, effective Jan. 1, 2024.

January 19, 2024

Hospital Services

· Inpatient Hospital Services – Under Billing, we added a new subsection titled Services with Gender or Procedure Code Conflict with information on how to bill for services that can be subjected to gender-specific editing.

Nursing Facilities

· Nursing Facilities – In the Legal References section, we added the citation for Minnesota Statutes, 256R.42 (Rate Adjustment for the First 30 Days).

January 18, 2024

Mental Health Services

· Intensive Residential Treatment Services (IRTS)

· Under the Eligible Providers heading, Provider Requirements, we clarified providers must have five to 16 beds and not be an institution for mental disease.

· Under the Billing heading, we clarified providers should bill room and board service days that are authorized by the managed care organization for medical assistance members directly to MHCP.

· Under the Authorization heading, we clarified providers need to submit the member's current individual treatment plan (ITP) and progress notes for two weeks.

Provider Basics
Provider Requirements

· Provider Screening Requirements – In the Revalidation Schedule section, we added March revalidations and updated the description for Home and Community-Based Services for January 2024 revalidations.

January 17, 2024

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

· Waiver and Alternative Care (AC) Programs – Specialized Equipment & Supplies Authorization & Billing Responsibilities – We updated the MHCP-Enrolled Provider Responsibilities section with the following text: "For procedure code, T2029, submit claim to MHCP without Medicare Coordination of Benefits (COB) information."

Hospital Services

· Inpatient Hospital Services

· Under Billing, Deliveries and Births, we added information about long-acting reversible contraceptives.

· Under Forms and Resources, we added a link to the Payment methodology for inpatient hospitals webpage.

January 16, 2024

Dental Services

· Dental Services – In the Covered Services section, we added the sentence, "Also see the MHCP Fee Schedule for a current list of all MHCP covered codes."

Provider Basics
Enroll with MHCP

· Pharmacy and Pharmacist Enrollment Criteria and Forms

· Under the How to Enroll as a Pharmacy and How to Enroll as an Individual Pharmacist sections, we added links to MCO In-Network Provider Agreement (DHS-8355) (PDF).

· Under Revalidation, we added more information about revalidation.

· Under Reporting Changes, we added more information about reporting changes.

· We updated language and formatting for clarity.

January 12, 2024

Provider Basics
Enroll with MHCP

· County Human Services Agency Enrollment Criteria and Forms – We added a recording of a training provided on the revalidation process in MPSE on Dec. 13, 2023.

Reproductive Health/OB-GYN

· Doula Services

· We updated language for clarity and to reflect legislation changes to enrollment and billing. Changes include the following.

· We added a Recommendation for Doula Services section.

· Under Eligible Providers:

· We removed text about doulas needing to be certified by one of the listed organizations and the list of organizations because this is no longer a requirement.

· We removed the section about Supervision because this is no longer a requirement.

· Under Documentation Requirements, we added details about what needs to be documented.

· We added a Telehealth section.

· Under Billing:

· We removed text about entering the NPI for the supervising physician, nurse practitioner or certified nurse midwife because this is no longer a requirement.

· We added details for billing as of Jan. 1, 2024 and prior to Jan. 1, 2024.

· We added instructions for how to bill if labor and delivery progresses over multiple days.

· Under Legal References, we added a link to the Code of Federal Regulations, title 42, chapter 4, subchapter c, part 440.130, c:

January 11, 2024

Child Welfare Targeted Case Management (CW-TCM)

· Child Welfare Targeted Case Management (CW-TCM) – Under the Covered Services heading, Interactive Video (ITV), Exception, and CW-TCM Activities and Services subheadings, we removed instructions to submit a claim as a telephone visit.

January 8, 2024

Early Intensive Developmental and Behavioral Intervention (EIDBI)

· EIDBI MCO Contact Information Grid – We updated contact information for some managed care organizations and reorganized the grid to be in alphabetical order by MCO.

January 3, 2024

Reproductive Health/OB-GYN

· Family Planning – Under Billing, we added that long-acting reversible contraceptives can be billed outside of a hospital labor and delivery bundle as of Jan. 1, 2024.

January 2, 2024

Transportation Services

· Local County or Tribal Agency Nonemergency Medical Transportation (NEMT) Services Claim, Service, and Rate Information – We added new mileage rates for Jan. 1, 2024.

January 1, 2024

Anesthesia Services

· Anesthesia Services – Under the Billing heading, we added the 2024 Anesthesia Rates table and removed the 2022 Anesthesia Rates table.

Dental Services

· Dental Benefits – We clarified language to reflect that dental benefits have no age or pregnancy status as qualifiers effective Jan. 1, 2024. These changes include the following:

· We updated the page title to Dental Benefits.

· We removed the text “Children through Age 20" from the Implant Services and Orthodontics section titles.

· We removed text about pregnant people and children from the Service Limits column in the tables.

· Dental Authorization Requirement Tables

· We updated the page title to Dental Authorization Requirement Tables. This change reflects that dental benefits have no age or pregnancy status as qualifiers effective Jan. 1, 2024.

· We removed the Preventive section.

· We update language for clarity.

· Dental Services

· Under Covered Services, we renamed the Dental Benefits for Children and Pregnant Women link to Dental Benefits. We also deleted the link to Dental Benefits for Non-Pregnant Adults.

· Under Authorization Requirements, we renamed the Authorization Requirement Tables for Children and Pregnant Women link to Authorization Tables for Dental. We also deleted the link to Authorization Requirement Tables for Non-Pregnant Adults.

· These changes reflect that dental benefits have no age or pregnancy status as qualifiers effective Jan. 1, 2024.

· Authorization Requirement Tables for Non-Pregnant Adults – We removed this manual page because dental benefits have no age or pregnancy status as qualifiers effective Jan. 1, 2024.

· Dental Benefits for Non-Pregnant Adults – We removed this manual page because dental benefits have no age or pregnancy status as qualifiers effective Jan. 1, 2024.

Equipment and Supplies

· Equipment and Supplies – We added a link to new Seizure Detection Devices section.

· Seizure Detection Devices – We created a new section of the MHCP Provider Manual for seizure detection devices.

Recuperative Care

· Recuperative Care – The Minnesota Department of Human Services will cover Recuperative Care program services effective Jan. 1, 2024, as part of its Minnesota Health Care Programs (MHCP). Recuperative care services are available to eligible MHCP members experiencing homelessness when they are unable to recover from a physical illness when unhoused or living in a shelter, but do not need to be hospitalized. Recuperative Care program services may include basic nursing care, counseling and social services.

Transportation Services

· State-Administered Transportation Procedure Codes, Modifiers and Payment Rates – We updated transportation mileage reimbursement rates for Jan. 1, 2024

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Previous Revisions

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