Children’s Mental Health Clinical Care Consultation

Revised: May 30, 2023

· Overview

· Eligible Providers

· Eligible Members

· Covered Services

· Noncovered Services

· Authorization

· Billing

· Legal References

Overview

Mental health clinical care consultation is communication between a treating mental health professional and other providers or educators who are working with the same member. These professionals use the consultation to discuss the following:

· Issues about the member's symptoms

· Strategies for effective engagement, care and intervention needs

· Treatment expectations across service settings

· Clinical service components provided to the member and family

Refer to Clinical Care Consultation Frequently Asked Questions webpage for more information.

Eligible Providers

Only a mental health professional or clinical trainee can bill for this service.

Eligible Members

To be eligible for mental health clinical care consultation, MHCP members must meet the following:

· Be age 20 or under

· Have a diagnosis of mental illness determined by a diagnostic assessment that includes a statement that indicates the medical necessity that requires consultation to other providers working with the child to effectively treat the condition.

Covered Services

MHCP covers mental health clinical care consultation between the treating mental health professional and another provider or educator. Appropriate providers and educators who may receive a consultation include the following but are not limited to:

· Adoption or guardianship workers

· After-school program staff

· Childcare providers

· Child protection workers

· Children’s mental health case managers

· Educators

· Guardians ad litem

· Home health care agencies

· Mentors

· Nurses

· Pediatricians

· Probation agents

Two mental health professionals treating the same client may consult; however, they need to split the time into two billable amounts comprising the total amount of time.

Mental health clinical care consultation may be done by telephone or face-to-face.

Documentation of Covered Services

Medical Necessity
Document the medical necessity for mental health clinical care consultation in the diagnostic assessment or in the individualized treatment plan (ITP). Submit this information with any request for authorization.

Individualized Treatment Plan
Document in the ITP the specific interventions, describing how the mental health professionals will use mental health clinical care consultation to treat the child’s mental illness.

Progress Notes
Document all mental health clinical care consultation in progress notes, including the following information:

· Mode of performance (phone or face to face)

· Type of service

· Date of service

· Start and stop time of the service unless the license holder is licensed as a residential program

· Location of the service

· The scope of the service, including the:

· targeted goal and objective;

· intervention that the staff person provided to the client and the methods that the staff person used;

· client's response to the intervention;

· staff person's plan to take future actions, including changes in treatment that the staff person will implement if the intervention was ineffective; and

· service modality

· The signature and credentials of the staff person who provided the service to the client

· The mental health provider travel documentation required by Minnesota Statutes 256B.0625, if applicable; and

· Significant observations by the staff person, if applicable, including:

· the client's current risk factors;

· emergency interventions by staff;

· consultations with or referrals to other professionals, family, or significant others; and

· changes in the client's mental or physical symptoms

Noncovered Services

Mental health clinical care consultation does not include the following:

· Communication between the treating mental health professional and a person under the clinical supervision of the treating mental health professional

· Written communication between providers

· Reporting, charting and record keeping (These activities are the responsibility of the provider)

· Mental health services not related to the member’s diagnosis or treatment for mental illness

· Communication provided during the performance of any of the following mental health services:

· Mental health case management

· Hospital in-reach services

· Intensive Rehabilitative Mental Health Services (IRMHS)

· Children’s Intensive Behavioral Health Services

Authorization Requirements

MHCP will authorize clinical care consultation in units of time. Refer to the Clinical care consultation billing information table under the Billing section.

Refer to the Authorization section of the MHCP Provider Manual for general authorization policy and procedures. Submit the following to the review agent as part of the authorization process for continuation of services:

· Copy of the most current diagnostic assessment

· Individual treatment plan that includes measurable and observable goals

· Progress notes that include all the above requirements

Billing

Bill Children’s Mental Health Clinical Care Consultation using MN–ITS 837P.

· Enter the treating provider NPI number on each claim line

· Submit one claim line per day for each service (Add up all the minutes of service provided for face-to-face or non-face-to-face services for each client for that day and submit a single claim regardless of the number of consultations)

· Use modifier U4 for non-face-to-face service

Clinical care consultation billing information

Procedure Code	Modifier	Brief Description	Unit	Service Limitations
90899	U8	Clinical care consultation, face to face	5 to 10 min.	Calendar year threshold, 15 hours. Upper limit of timed unit to be counted to the threshold.
90899	U9	Clinical care consultation, face to face	11 to 20 min.
90899	UB	Clinical care consultation, face to face	21 to 30 min.
90899	UC	Clinical care consultation, face to face	31 min. and above

Legal References

Minnesota Statutes 256B.0671, subdivision 7, Mental health clinical care consultation
Minnesota Statutes 245I Mental Health Uniform Service Standards Act