Provider Manual

· Rehabilitative Services Procedure Codes – Added new 2014 CPT speech codes: 92521, 92522, 92523, 92524; Replaced code 0183T with new 97610 (wound care).

12/30/2013
Addition(s)/Revisions

Provider Basics
Provider Requirements

· Minnesota Family Planning Program (MFPP) Procedure Codes (PDF) – As of 1.1.14, J7301 replaces Q0090 for IUDs that release 13.5mg of levonorgestrel.

12/16/2013
Addition(s)/Revisions

· Individual PCA Enrollment Criteria – Added clarification in the processing timelines section for individual PCA affiliation/enrollment requests including timelines for processing corrected and resubmitted requests and contacting the call center about application requests.

12/12/2013
Addition(s)/Revisions

Provider Basics
Billing Policy Overview

· Medicare and Other Insurance – Added instruction for submitting different procedure codes to MHCP. New MN–ITS Screens allow TPL to be submitted at the Line/Level for line by line adjudication.

12/11/2013
Addition(s)/Revisions

· Non-Pregnant Adults – Tissue conditioning codes D5850-D5051 added to the covered services section.

12/09/2013
Addition(s)/Revisions

Equipment and Supplies

· Electrical Stimulation Devices – Updated with non-coverage decision for new HCPCS codes under Non-Covered Services.

Pharmacy Services – Removed reference to ICD-9.

12/06/2013
Addition(s)/Revisions

Laboratory/Pathology, Radiology & Diagnostic Services

· Children and Pregnant Women – Incorporated x-ray limits for Children's Dental Radiographs.

12/04/2013
Addition(s)/Revisions

· Radiology/Diagnostic Services – Added policy related to Advanced Diagnostic Imaging Accreditation (ADIA) under Eligible Providers.

12/02/2013
Addition(s)/Revisions

HCBS (Home and Community Based Services) Waiver Services

· Home and Community Based Services (HCBS) Waiver and Alternative Care (AC) Provider Enrollment – Added requirement to verify entities affiliated with the provider are not on the MN Exclusions list and clarified ownership changed must be reported 30 days before they occur under ongoing requirements.

Provider Basics
Authorization

· Drug Authorizations – Effective 12/01/2013 Hours of operation for HID will be 8:00 AM - 5:30 PM.

· Adult Rehab Mental Health Services (ARMHS) – Clarified that community hospital setting is a higher level service provider for Transition to Community Living services. Added Diagnostic Assessment reference to eligible recipient criteria.

· Intensive Residential Treatment Services (IRTS) – Added reference and link to Diagnostic Assessment in admission criteria.

Physician and Professional Services – Revised for ICD diagnosis code reference.

· Transplant Authorization Code List (PDF) – Revised for ICD diagnosis code reference.

11/21/2013
Addition(s)/Revisions

· Dental Therapist (DT) – Removed taxonomy information.

11/20/2013
Addition(s)/Revisions

· Advanced Dental Therapist (ADT) – Removed taxonomy information.

11/19/2013
Addition(s)/Revisions

Dental Services Overview

· Authorization Requirement Tables for Children and Pregnant Women – Orthodontic documentation requirements added to the orthodontic section of the authorization chart.

11/07/2013
Addition(s)/Revisions

· Minnesota Family Planning Program (MFPP) Procedure Codes (PDF) – Replaced discontinued code 86781 Antibody; Treponema pallidum, confirmatory test (eg, FTA-abs) with valid 2013 CPT code 86780.

11/04/2013
Addition(s)/Revisions

Laboratory/Pathology, Radiology & Diagnostic Services

· Authorization Requirement Tables for Non Pregnant Adults – Clarified adult prophylaxis fee-for service authorization criteria and the MCO coverage information related to the additional prophylaxis services for those enrolled in a MCO.

Transportation Services

· Access Transportation Services (ATS) – Added Multiple Riders chart.

10/28/2013
Addition(s)/Revisions

Dental Services (Overview) – Removed references to ICD-9 diagnosis code.

· Radiology/Diagnostic Services – Changed ICD-CM to ICD.

10/25/2013
Addition(s)/Revisions

Pay-for-Performance Program (P4P) – Changed ICD-CM to ICD.

· Program HH Dental Authorization Requirement Chart – Removed references to ICD-9 diagnosis code.

· Minnesota Family Planning Program (MFPP) – Changed ICD-CM to ICD.

10/22/2013
Addition(s)/Revisions

· Ventilators – Effective 1/1/2014, breathing circuits are not separately reimbursed under Billing.

· Assertive Community Treatment (ACT) – Added Diagnostic Assessment reference to eligible recipient criteria.

· Casting & Strapping Services/Supplies – Deleted codes 29220 and 29590; updated authorization statements.

10/15/2013
Addition(s)/Revisions

· Diagnostic Assessment – Clarified to include description of the type of diagnostic assessment on the written report under Covered Services.

Physician and Professional Services – Clarified global surgical package follows Medicare guidelines for days covered.

Laboratory/Pathology, Radiology & Diagnostic Services

· Audiology Service Thresholds – Removed codes 92506 and 92510.

· Orthotic Procedures – Clarified authorization requirements for orthotics.

10/14/2013
Addition(s)/Revisions

Acupuncture Services – Removed reference to ICD-9 diagnosis code.

Child and Teen Checkups (C&TC) – Removed links from the C&TC FACT sheets, and separated the Mental Health Screening, 6-21 Years and the Social-Emotional Screening, 0-5 Years Fact sheets.

Chiropractic Services – Removed reference to ICD-9 diagnosis code.

Hearing Aid Services – Removed reference to ICD-9 diagnosis code.

Provider Basics
Programs and Services – Added information about the State Medical Review Team (SMRT) for applicants with disabilities.

10/10/2013
Addition(s)/Revisions

Elderly Waiver (EW) and Alternative Care (AC) Program – New HCPCs, definition and covered services, service names, adding more information.

10/08/2013
Addition(s)/Revisions

· Laboratory/Pathology Services – Modifier 99 directions were updated. Refer to the Laboratory/Pathology Services Modifiers section.

Physician and Professional Services – Clarified Payment Limitations for Debridement or Reduction of Nails, Corns and Calluses.

10/04/2013
Addition(s)/Revisions

· Inpatient Visits – Added Physician Assistants to eligible providers.

10/01/2013
Addition(s)/Revisions

Rehabilitative Services – Updated rehab services authorization policy and revised language to reflect recent changes to MN Rules, including enrollment requirements, definitions and review of the plan of care to at least once every 90 days.

· Orthotic Procedures – Updated authorization requirements on the Orthotic Procedures list.

09/30/2013
Addition(s)/Revisions

· Non-Pregnant Adults – Clarified coverage limits on the adult prophylaxis. MHCP allows one per calendar year. Additional adult prophylaxis requires authorization and is allowed if it meets the defined criteria. Removed consolidated language.

Transportation Services (Overview)

· Rehabilitative Services Procedure Codes – Removed code 97020 (microwave) added text to codes 97039 and 97799.

09/27/13
Addition(s)/Revisions

· Ambulance Transportation Services – Updated Diagnosis codes.

09/26/2013
Addition(s)/Revisions

· Abortion Services – Clarified information about history and physician exams done on the same day as the procedure under Covered Services. Clarified process for submitting the Medical Necessity Statement under Billing.

09/19/2013
Addition(s)/Revisions

Eyeglass and Vision Care Services – Corrected contact lens codes.

· Free-Standing Birth Center Services – Clarified covered and non-covered services and billing instructions.

09/18/2013
Addition(s)/Revisions

· Intensive Residential Treatment Services (IRTS) – Added documentation criteria to the Authorization section.

09/17/2013
Addition(s)/Revisions

· Obstetric Services and HIV Counseling – Clarified prenatal screening tool requirements under Covered Services.

09/12/2013
Addition(s)/Revisions

Acupuncture Services – Clarified the policy for Covered Services.

09/10/2013
Addition(s)/Revisions

· Program HH (HIV/AIDS) Covered Services – Updated covered Mental Health services information.

09/06/2013
Addition(s)/Revisions

· Minnesota Family Planning Program (MFPP) Procedure Codes – Added code 11982 - Remove drug implant device.

09/04/2013
Addition(s)/Revisions

Immunization and Vaccinations – Qualifying enhanced primary care providers who administers Mn-VCF vaccines will be paid at the enhanced administration fee for calendar year 2013-2014. Refer to the Primary Care and VFC Incentive Program web page for more information.

09/03/2013
Addition(s)/Revisions

Rehabilitative Services – Updated the Guidelines for Documentation of Occupational Therapy (PDF) under Documentation Requirements.

08/30/2013
Addition(s)/Revisions

Health Care Programs and Services Overview – Added coinsurance to the services covered under QMB.

08/27/2013
Addition(s)/Revisions

· Critical Access Dental Payment Program (CADPP) – Deleted old information for dates prior to 2011. Updated page to exclude reference to session laws since they have now been codified.

08/20/2013
Addition(s)/Revisions

Provider Basics
Provider Requirements

· Non-Pregnant Adults – MCO's will begin coverage of the additional non-pregnant adult dental services effective 7/1/13.

· Individual PCA Enrollment Criteria – Updated steps to verify PCA qualifications including checking the MN Excluded Providers Lists.

08/19/2013
Addition(s)/Revisions

Dental Services (Overview) – Multiple surgery section updated and new CMS Sleep Apnea guidelines.

· Obstetric Services and HIV Counseling – Updated the Evidence-Based Childbirth Program text.

08/16/2013
Addition(s)/Revisions

Community Health Worker – Updated eligible providers to supervise CHW's to include mental health professionals. Included links to the mental health legislation and the CHW's Applicant Assurance Statement form.

08/15/2013
Addition(s)/Revisions

· Non-Pregnant Adults – Additional services were added for adult prophylaxis D1110, oral and IV sedation D9241 - D9242, D9248 and house/extended care calls D9410 effective 7/1/13 for fee-for service recipients.

08/14/2013
Addition(s)/Revisions

Mental Health Services – Added references to supervision requirements and instructions for professionals that are ineligible for enrollment as a Medicare provider.

08/13/2013
Addition(s)/Revisions

· Authorization Requirement Tables for Non Pregnant Adults – Non-pregnant Adults authorization criteria added clarification that radiographs and x-rays need to be copies not original. Partial dentures documentation can be on the ADA 2012 form or on their clinical charting document. Updated the oral surgery requirements for referrals.

Pharmacy Services – Added text to clarify that pharmacy provider must bill prescription drugs using their NCPDP D.0 (Point of Sale) software. Also added a reminder that pharmacies cannot bill for drugs administered in a clinic.

· Free-Standing Birth Center Services – Added code billing information and a link to Laboratory/Pathology Services for information about billing Newborn Metabolic Disorder Screening services done by the Minnesota Department of Health (MDH).

08/12/2013
Addition(s)/Revisions

Laboratory/Pathology, Radiology & Diagnostic Services

· Authorization Requirement Tables for Children and Pregnant Women – Children & pregnant women authorization criteria added clarification that radiographs and x-rays need to be copies not original. Partial dentures documentation can be on the ADA 2012 form or on their clinical charting document. Updated the oral surgery requirements for referrals and added new orthodontic criteria.

Pharmacy Services

· Home Infusion Therapy – Added text/clarification information Home Infusion Nurse visits and TPN billing.

08/06/2013
Addition(s)/Revisions

Community Paramedic Services – Programs HH and QM are not covered under Community Paramedic Services under Eligible Recipients.

· Laboratory/Pathology Services – Under Covered Services clarified provider types who may order lab services. Under Specimen Collection and Handling added new coverage indications for MDH newborn screening program and added heading MDH Infectious Disease Reporting to clarify coverage indication for CPT code 99000. Added new heading Pathology Services Claiming to describe current and new pathology institutional claiming and reimbursement policy. Under heading Drug Testing clarified coverage indications and removed CPT coding guidance.

Provider Basics
Billing Policy Overview

· Payment Methodology - Non-Hospital – Updated Family Planning legislative rate increase information and procedure code list.

08/05/2013
Addition(s)/Revisions

Individualized Education Program (IEP) Services – Updated text for clarifications, fixed links. Removed references to Licensed Psychological Practitioner from mental health professional definition.

Laboratory/Pathology, Radiology & Diagnostic Services

· Radiology/Diagnostic Services – Under covered services clarified provider types who may order radiology services.

08/01/2013
Addition(s)/Revisions

Child and Teen Checkups (C&TC) – Added the 6-21 mental health screen Fact Sheet under Developmental and Mental Health screening. Added information about the Fluoride Varnish consent form.

· Airway Clearance Devices – Updated policy for high frequency chest wall oscillation systems under Covered Services.

07/26/2013
Addition(s)/Revisions

Laboratory/Pathology, Radiology & Diagnostic Services

· Specialized Wound Treatment Technology – Revised policy regarding nutritional status under Documentation for Authorization Requests, Documentation for Authorization Requests, and Billing.

07/24/2013
Addition(s)/Revisions

Equipment & Supplies – Removed referring provider, replaced with ordering provider under Billing Policy.

Hospital Services

· Outpatient Hospital Services – Revised the Cardiac Rehabilitation section and replace the requirement of a physician in the exercise area with "All settings must have a physician immediately available and accessible for medical consultations and emergencies at all times when items and services are being furnished under the program".

07/23/2013
Addition(s)/Revisions

Pharmacy Services – Corrected links and fixed text for Tamper Resistant prescription blanks.

07/18/2013
Addition(s)/Revisions

· Radiology/Diagnostic Services – Retitled the Service Requiring Authorization heading to Exceptions to Services Requiring Authorization and clarified language regarding when outpatient imaging services do not require authorization.

· Minnesota Family Planning Program (MFPP) Procedure Codes (PDF) – Added Q0090 (hormone releasing IUD, 13.5mg) to the Minnesota Family Planning Program (MFPP) Procedure Codes list.

07/15/2013
Addition(s)/Revisions

Transportation Services

· Access Transportation Services (ATS) – Added transport recipient to a provider within 30 miles for primary care and 60 miles for specialty care provider under Covered Services.

07/12/2013
Addition(s)/Revisions

· Diabetic Equipment & Supplies – Removed referring provider, replaced with ordering provider under Billing.

· Electrical Stimulation Devices – Removed referring provider, replaced with ordering provider under Billing.

· Lower Limb Prosthetics – Removed referring provider, replaced with ordering provider under Billing.

Hospital Services – Added Links to the Inpatient Hospital Authorization and Hospital In-reach Service Coordination sections.

· Critical Access Hospital (CAH) Services – Added links to the Inpatient Hospital Authorization and Hospital In-reach Service Coordination sections.

· Inpatient Hospital Services – Added links to other hospital services sections.

Physician and Professional Services

· MHCP Professional Certification & Enrollment Requirements – Added new qualifications to chart due to rule 47 changes.

07/11/2013
Addition(s)/Revisions

Hospital Services

· Hospital In-reach Service Coordination (IRSC) – New section.

· Health Care Homes (HCH) – MDH is now adding the NPI's/UMPI's to the MDH HCH Certification - Report. Updated the certification notification instructions for providers.

07/10/2013
Addition(s)/Revisions

Dental Services
Allied Oral Health Professional (Overview)

· Limited Authorization (LA) Dental Hygienists – Removed link to old provider update Limited Authorization Dental Hygienist Enrollment and Reimbursement Changes under Additional Resources.

· Adult Day Treatment – Added requirements for authorization documentation and Targeted Clinical Services. Clarified recipient eligibility criteria and ITP requirements.

· Children’s Mental Health Crisis Response Services – Removed Licensed Psychological Practitioner from Enrollable Mental Health Professionals.

Provider Basics
Provider Requirements – Removed Licensed Psychological Practitioner from eligible providers list.

Relocation Service Coordination—Targeted Case Management (RSC—TCM) – Removed Licensed Psychological Practitioner from Provider Type Home Page Links.

07/09/2013
Addition(s)/Revisions

Physician and Professional Services – Added link to DHS QUITPLAN Services under Smoking Cessation Services

07/03/2013
Addition(s)/Revisions

Physician and Professional Services – Clarified the policy for Male Circumcision and enrolled APRN services.

· Community Paramedic Services – New section

06/24/2013
Addition(s)/Revisions

Hospital Services

· Outpatient Hospital Services – Removed reference to GAMC.

06/20/2013
Addition(s)/Revisions

Community Health Worker – If the billing provider is not the same as the ordering provider the billing provider must meet the same documentation requirements listed in the billing section.

06/06/2013
Addition(s)/Revisions

· Emergency Medical Assistance – Removed 6/30/13 end date for dialysis and cancer treatment. Clarified Pharmacy authorization and CPC process, and added instruction for single diagnosis in the billing section.

06/05/2013
Addition(s)/Revisions

HCBS Waiver Services

· Home and Community Based Services (HCBS) Waiver and Alternative Care (AC) Provider Enrollment – Removed "copy of contract" as an option for showing proof of qualifications during the record review.

05/30/2013
Addition(s)/Revisions

Hearing Aid Services – Clarified replacement policy.

05/29/2013
Addition(s)/Revisions

Immunization and Vaccinations – Fixed typo - code listed as G1010 Hep B (initial) was changed to G0010 under Vaccine Administration CPT Code.

05/28/2013
Addition(s)/Revisions

· Children’s Therapeutic Services and Supports (CTSS) – Revised Authorization requirements to include services with Interactive Complexity.

· Inpatient Visits – Removed expired CPT code information.

05/24/2013
Addition(s)/Revisions

· Critical Access Hospital (CAH) Services

· Incontinence Products – Under Covered Services, added link to the 2013 Incontinence Product list.

Hospital Services - The Hospital Services section has been separated into:

· Inpatient Hospital Services

· Outpatient Hospital Services

Pharmacy Services – Added text to clarify information for pharmacist administered vaccine and prescription refill.

05/14/2013
Addition(s)/Revisions

Physician and Professional Services

· Assertive Community Treatment (ACT) – Revised link in eligible provider requirements to Minnesota ACT Standards document.

05/10/2013
Addition(s)/Revisions

Chiropractic Services – Clarified annual benefit limits and removed authorization information about additional E&M codes.

· Pay-for-Performance Program (P4P) – Clarified billing instructions, providers must submit the P4P claim with the correct clinic NPI/UMPI location where the E&M and laboratory visits were performed.

05/09/2013
Addition(s)/Revisions

Billing Policy Overview – Added a link to the new Subrogation section.

· Medicare and Other Insurance – Added Subrogation section.

05/07/2013
Addition(s)/Revisions

· Obstetrics Services – Clarified submitting breast pump rental claim under infant ID number in the Breast Pumps section.

05/03/2013
Addition(s)/Revisions

Physician and Professional Services – Updated POS when inpatient status; deleted first sentence under Physician Services While Recipient is Inpatient Status. Deleted Additional Authorization Procedure Codes section – form was eliminated.

05/02/2013
Addition(s)/Revisions

· Minnesota Family Planning Program (MFPP) Procedure Codes – Added Procedure Code 57150 - Vag irrigate/med app tx

05/01/2013
Addition(s)/Revisions

· Abortion Services – Removed reference to GAMC under Eligible Recipients.

04/25/2013
Addition(s)/Revisions

HCBS Waiver Services –.Multiple text clarifications through the entire manual section.

· Diagnostic Assessment – Revised with changes for 2013 CPT codes.

04/19/2013
Addition(s)/Revisions

Laboratory/Pathology, Radiology & Diagnostic Services

· Positive Airway Pressure for Treatment of Obstructive Sleep Apnea – Clarified when coverage can continue after 12 weeks under Covered Services.

04/16/2013
Addition(s)/Revisions

· Laboratory/Pathology Services – Genetic Testing Modifiers for molecular diagnostic or cytogenetic studies are no longer required after 12/31/12.

04/15/2013
Addition(s)/Revisions

Transportation Services
Ambulance Transportation Services

· Non-Pregnant Adults – Under Outpatient Dental Surgery Services we removed D9241 & D9248 from adjunction services as they are not covered in the non-pregnant adult benefit set since 1-1-2010.

04/08/2013
Addition(s)/Revisions

Billing Policy Overview – Reconsideration of the claim section added. Revised coding schemes resources - removed reference to Ingenix.

Equipment & Supplies – Removed B4087 U3 from the specialized auto pricing with long description list and added A4649 under Billing Miscellaneous Codes

04/04/2013
Addition(s)/Revisions

HCBS Waiver Services

· Home and Community Based Services (HCBS) Waiver and Alternative Care (AC) Provider Enrollment – Added section about waiver/AC record review process

04/03/2013
Addition(s)/Revisions

· Acceptable Ambulance Diagnosis Codes – Diagnosis code span 646.90 to 646.93 added to the Acceptable Diagnosis Code lists for ground ambulance codes A0427, A0433 and A0429

03/29/2013
Addition(s)/Revisions

· Minnesota Family Planning Program (MFPP) – Coding sections were combined into one MFPP Procedure Code list. Pharmacy section was moved to the covered services section. Clarified additional MFPP diagnosis and training information available to the provider.

03/28/2013
Addition(s)/Revisions

Billing Policy Overview

· Minnesota-defined U Modifiers – Added procedure codes to: U6 Money Follows the Person – all; UA Item, service, or procedure furnished in conjunction with a demonstration project – T2038; UA Night supervision – S5136

Provider Basics
Provider Requirements

· Children and Pregnant Women – Effective 5/1/13 updated orthodontic criteria approved by the Dental Services Advisory Committee (DSAC)

Health Care Programs and Services Overview – Updated information for designated provider spenddowns and updated EMA changes. Incarcerated recipients added recoupment of claims paid during an incarceration period and who to contact for billing information.

Laboratory/Pathology, Radiology & Diagnostic Services – Removed reference to GAMC

03/27/2013
Addition(s)/Revisions

Provider Basics

· Authorization – MHCP announces a new Medical Review Agent for Medical and Home Care services effective 4/1/13

03/25/2013
Addition(s)/Revisions

Clinic Services

· Federally Qualified Health Center and Rural Health Clinics – Clarified provider based billing/multiple same day encounter exception under Covered Services

03/22/2013
Addition(s)/Revisions

· Access Services – Moved the AC program to a program that does not cover Access interpreter services under Eligible Recipients

03/21/2013
Addition(s)/Revisions

Child and Teen Checkups (C&TC) – Clarified text under Developmental and Mental Health Screenings to identify the instruments recommended by Minnesota and clarified text under TB Risk indicating all children should be screened for TB risk, but children at high risk for exposure should receive the TB test.

03/19/2013
Addition(s)/Revisions

Relocation Service Coordination—Targeted Case Management (RSC—TCM) – Removed reference to the MnDHO program that ended at the end of 2010.

03/11/2013
Addition(s)/Revisions

Physician and Professional Services

· Adult Crisis Response Services – Revised Authorization Requirements for Residential Crisis Stabilization

· Health Care Homes (HCH) – Clarified HCH Certification process effective 12/6/12, NPI's/UMPI's must be written on the MDH report or a on a separate document with the MDH report and faxed to provider enrollment.

03/05/2013
Addition(s)/Revisions

· Children’s MH Residential Treatment – Tribes allowed to bill treatment portion of CMHRT service for American Indian children

Provider Basics
Provider Requirements – Added new section Payment Reversals for Terminated Providers

03/04/2013
Addition(s)/Revisions

· Positive Airway Pressure for Treatment of Obstructive Sleep Apnea – Clarified that authorization is available for excess quantities of supplies under Authorization

03/01/2013
Addition(s)/Revisions

Chiropractic Services – Clarified covered subluxation x-ray information under Covered Services

Equipment & Supplies – Added information about NCCI. Remove information under billing policy indicating that the service lines note field could not be used if a model number was reported. Added links to the MN-ITS User Guide and the Minnesota Uniform Companion guide.

Pharmacy Services

· Home Infusion Therapy – Added span of codes S9490-S9504 instead of S9490, S9504 under Covered Services

02/22/2013
Addition(s)/Revisions

Anesthesia Services – Updated the Anesthesia Payment Formulas for 2013

02/20/2013
Addition(s)/Revisions

Rehabilitative Services – Under Practitioners with Temporary License and Non-Covered Services to clarify that the temporary license or permit must be valid and to be paid services provided must be within the time span on the temporary license or permit.

02/19/2013
Addition(s)/Revisions

Alcohol and Drug Abuse Services – Added code changes effective 3/1/13 to Outpatient Group (Non-residential) treatment and Non-residential Treatment - Medication Assisted Therapy (MAT) under Revenue & Procedure Codes section. Added clarifying information overall.

Provider Basics
Authorization – Added text to clarify the Notice for Reconsideration when an authorization has been denied

02/14/2013
Addition(s)/Revisions

Laboratory/Pathology, Radiology & Diagnostic Services

· Incontinence Products – Revised coverage policy for all incontinence products for dates of service 4/1/13 and beyond

02/13/2013
Addition(s)/Revisions

· Laboratory Authorization Code List (PDF) – Effective DOS through 12/31/12 heavy metal screening (CPT codes 83015 & 83018) no longer require PA. Effective DOS 1/1/13 forward report BRCA testing with CPT codes 81211-81217. Effective 12/31/12 83890-83909 are discontinued. Effective 3/31/12 S3818, S3819, S3820 and S3822 are discontinued.

02/11/2013
Addition(s)/Revisions

· Nutritional Products and Related Supplies – Revised non-coverage statement about thickeners due to FDA caution under Non-Covered Services

02/05/2013
Addition(s)/Revisions

Child and Teen Checkups (C&TC) – Made changes to the billing portions, maternal depression, component exception, referral condition code. Fixed the language on billing when services are in two separate months.

01/29/2013
Addition(s)/Revisions

· Pressure Reducing Support Surfaces – Changed policy related to nutritional status

01/28/2013
Addition(s)/Revisions

Clinic Services – Updated chart under Billing for PHNC Services for Individual patient education, per AUC Best Coding Recommendations

· Nutritional Products and Related Supplies – Revised policy regarding supplements for recipients with chronic wounds. Revised policy regarding thickeners.

01/18/2013
Addition(s)/Revisions

· Ambulatory Assist Equipment – Clarified under Eligible Recipients that gait trainers may be covered for recipients in SNF/ICF-DD

01/17/2013
Addition(s)/Revisions

Health Care Homes (HCH) – Under Eligible Providers - HCH certification/renewal - removed the word annual

Pharmacy Services – Added text related to 90-day supply overrides for recipients with TPL. Also added text about physician-administered drugs.

01/14/2013
Addition(s)/Revisions

· CTSS Children’s Day Treatment – Added criteria for interactive service delivery. Added link to new CTSS section.

· Children’s Therapeutic Services and Supports (CTSS) – Added service limits to the billing table

· Psychotherapy – Added service limits to billing table

01/11/2013
Addition(s)/Revisions

· Emergency Medical Assistance – Added information about expedited review of CPC requests for recipients awaiting hospital discharge and added information that a CPC is valid for 12 months and added information about the CPC renewal process.

01/09/2013
Addition(s)/Revisions

Provider Basics
Billing Policy

· Mobility Devices – Clarified criteria for Group 3 power wheelchairs

01/08/2013
Addition(s)/Revisions

· Billing the Recipient – Updated Family Deductible information