Allergen-Reducing Products for Children

Revised: April 5, 2023

· Overview

· Eligible Providers

· Eligible Members

· Covered Services

· Authorization

· Billing

Overview

Minnesota Health Care Programs (MHCP) covers certain allergen-reducing products for children with poorly controlled asthma.

Eligible Providers

The following providers may provide allergen-reducing products:

· Federally qualified health centers

· Home health agencies

· Indian health services

· Medical suppliers

· Pharmacies

· Rural health clinics

· Public health nursing clinics

· Public health clinics

· Durable medical equipment providers

An allergen-reducing product must be prescribed by one of the following MHCP-enrolled treating providers:

· Physician

· Physician’s assistant

· Advanced practice nurse

Other health care professionals, such as registered environmental health specialist, healthy homes specialist, lead risk assessor, certified asthma educator, and public health nurses, can make recommendations to MHCP-enrolled treating providers about allergen-reducing products for the child.

Third Party Liability (TPL) and Medicare

Providers must meet any provider criteria, including accreditation, for third-party insurance or for Medicare to assist members for whom MHCP is not the primary payer.

Eligible Members

All MHCP members under the age of 21 for Medical Assistance and under the age of 19 for MinnesotaCare members who are diagnosed as having poorly controlled asthma. The Minnesota Legislature has defined a person as having poorly controlled asthma when they have experienced one of the following:

· A hospital emergency department visit for asthma at least one time in the past year; or

· A hospitalization for the treatment of asthma at least one time in the past year.

Covered Services

All covered products require an order from a physician, physician assistant, nurse practitioner or clinical nurse specialist.

MHCP will cover the following allergen-reducing products:

· Allergen encasements for mattresses, box springs and pillows

· An allergen-rated vacuum cleaner, filters and bags

· A dehumidifier and filters

· A HEPA single-room air cleaner and filters

· Integrated pest management, including traps and starter packages of food storage containers

· A damp mopping system

· A waterproof hospital-grade mattress (if the member does not have access to a bed)

· Furnace filters (for homeowners only)

Authorization

MHCP does not require prior authorization for any allergen-reducing products.

Billing

Please refer to Billing Policy Overview for details.

· Bill all allergen-reducing products under miscellaneous code E1399. Use modifier HA to denote you are billing for a child. A child includes those age 21 and younger but you must also follow MinnesotaCare and Medicaid policy for who is considered a child.

· Include a manufacturer’s pricing document. (If this is not available, an invoice is acceptable documentation.)

· Use MN–ITS 837P Professional or X12 Batch.

Reimbursement

Reimbursement is the manufacturer’s retail price minus 20%, or provider’s cost listed on the invoice plus 20%.

Legal References

Minnesota Statutes, 256B.0625, subdivision 31 (h) (Medical supplies and equipment)
Minnesota Statutes, 256B.0625, subdivision 67 (Enhanced asthma care services)