MHCP Provider Manual

Latest Manual Revisions

Revised: March 6, 2023

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.

March 6, 2023

Mental Health Services

· Psychotherapy – Under Billing in the Mental health psychotherapy benefits for children and adults table, we added that you can now bill two units of 90837 for prolonged psychotherapy services face to face with the member for 91 minutes or more.

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March 3, 2023

Dental Services

· Dental Benefits for Children and Pregnant Women – We added the following new procedure codes under Diagnostic Imaging in the Diagnostic section.

· D0372 - Intraoral tomosynthesis - comprehensive series of radiographic images

· D0373 - Intraoral tomosynthesis - bitewing radiographic image

· D0374 - Intraoral tomosynthesis - periapical radiograpic image

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March 2, 2023

COVID-19

· Coronavirus (COVID-19) – In the Home Care and PCA Services section, in Family Members Providing Services for MHCP-Enrolled Members, we added the end date for this policy modification of May 11, 2023, which is the end of the federal public health emergency.

Dental Services

· Dental Benefits for Non-Pregnant Adults – We added the following new procedure codes under Diagnostic Imaging in the Diagnostic section.

· D0372 - Intraoral tomosynthesis - comprehensive series of radiographic images

· D0373 - Intraoral tomosynthesis bitewing radiographic image

· D0374 - Intraoral tomosynthesis - periapical radiograpic image

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February 24, 2023

Dental Services

· Authorization Requirement Tables for Non-Pregnant Adults

· Under Prophylaxis, we updated the vendor link to the Kepro/MHCP website for submitting authorization requests. We also replaced Authorization Request: D1110 Multiple Prophylaxis (DHS-7979)(PDF) with the Authorization Request on the Kepro/MHCP website.

· Under Oral Surgery–Removal of Impacted Teeth, we updated the vendor link to the Kepro/MHCP website for submitting authorization requests. We also listed the Oral and Maxillofacial Surgery Medical Necessity Questionnaire and updated periodontal details.

Mental Health Services

· Mental Health Provider Travel Time – Under Billing, we added a hyperlink to MN–ITS 837P.

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February 23, 2023

Behavioral Health Home Services

· Behavioral Health Home Services

· Under Billing, we clarified claims submitted by a mental health billing entity must include the rendering NPI of the MHCP-enrolled team member.

· Under Managed Care, we clarified Behavior Health Home (BHH) services providers need to contact the individual's MCO to determine what the MCO requires on the claim for BHH services.

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February 22, 2023

Dental Services

· Authorization Requirement Tables for Children and Pregnant Women

· Under Endodontics, we clarified that endodontic endosseous implant treatment requires prior authorization.

· Under Oral and Maxillofacial Surgery, we updated the vendor link to the Kepro/MHCP website for submitting authorization requests. We also listed the Oral and Maxillofacial Surgery Medical Necessity Questionnaire.

· Under Orthodontics, we updated the vendor link to the Kepro/MHCP website for submitting authorization requests. We also added the Orthodontia Medical Necessity Questionnaire.

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February 16, 2023

Officer-Involved Community-Based Care Coordination Services

· Officer-Involved Community-Based Care Coordination Services – Under Eligible Providers, we deleted Counties are required to pay the nonfederal share (50% of the estimated total cost) of the service at initial enrollment as well as on an ongoing basis.

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February 15, 2023

COVID-19

· Coronavirus (COVID-19)

· In the Eligible Providers section, under Providers Eligible to Administer COVID-19 Vaccines, we added that students in a healthcare profession but not enrolled in MHCP are approved to administer COVID-19 vaccines.

· In the Vaccines section, under COVID-19 Vaccine and Administration Codes, we updated ages to the following CPT vaccine codes.

· 91301: Moderna vaccine, updated to 12 years and older

· 91304: Novavax vaccine, updated to 12 years and older

· In the Vaccines section, under COVID-19 Vaccine and Administration Codes, we added the following CPT vaccine codes.

· 91314: Moderna vaccine, 6 years - 11 years

· 91315: Pfizer-BioNTech vaccine, 5 years - 11 years

· 91316: Moderna vaccine, 6 months - 5 years

· 91317: Pfizer-BioNTech vaccine, 6 months - 4 years

· In the Vaccines section, under COVID-19 Vaccine and Administration Codes, we updated the use with and effective date information for the following CPT administration code.

· 0041A: Novavax, added Report 0044A for the booster dose with the effective date of Oct. 19, 2022.

· In the Vaccines section, under COVID-19 Vaccine and Administration Codes, we added the following CPT administration codes.

· 0144A: Moderna, administration of single booster dose

· 0154A: Pfizer-BioNTech, administration of single booster dose

· 0164A: Pfizer-BioNTech, administration of single booster dose

· 0173A: Pfizer-BioNTech, administration of third dose

· Additionally, we updated language for clarity.

Mental Health Services

· Mental Health Services - Level of Care Assessment and Necessity of Care Recommendation or Referral

· Under Eligible Providers, we removed Adult Mental Health Targeted Case Management information.

· Under Legal References, we deleted a link to Minnesota Statutes 256B.0625.

Physician and Professional Services

· Physician and Professional Services

· In the Eligible Asthma Services Providers section, we added a list of the providers who can bill for a home assessment.

· In the Billing for Asthma Services section, we clarified the billing text.

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February 14, 2023

Provider Basics
Enroll with MHCP

· Individual PCA or DSW Enrollment Criteria and Forms

· In the section, How to Enroll, we clarified the two options to enroll as using the MPSE online portal or submitting required documents by fax.

· We clarified the text in the Background Study section.

· We clarified the text in the Reinstating an inactive affiliation section.

· We added a section for Revalidation.

· We updated the section on Reporting Changes.

· Rehabilitation Agency Enrollment Criteria and Forms – Under Enrollment Criteria, we added Minnesota Provider Screening and Enrollment portal instructions.

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February 10, 2023

Equipment and Supplies

· Mobility Devices – Under Covered Services, we added the Backup Manual Wheelchairs section. Also also updated requirements for ultra-lightweght, lightweight and tilt-in-space wheelchairs in the Manual Wheelchairs section.

Nursing Facilities

· Nursing Facilities

· We have reorganized the content of this manual page for clarity.

· We added an Overview section to explain Minnesota Health Care Programs (MHCP) role in providing nursing facility services.

· We organized content into Covered Services and Noncovered Services sections to clarify the services that MHCP covers and does not cover.

· We added a section for Medicare and Other Insurance.

· We have moved the Swing Bed Hospital Services section to a separate Swing Bed Hospital Services manual page.

· We moved the Conditions of Participation section to the Nursing Facility Enrollment Criteria and Forms manual page.

· In the Billing section, under Resident Classification System, we included links to the Minnesota Case Mix Review Program and Case Mix Information published on the Minnesota Department of Health website.

· We removed outdated legal references in the Legal References section.

Provider Basics
Enroll with MHCP

· Rehabilitation Billing Entity Enrollment Criteria and Forms – Under Enrollment Criteria, we added Minnesota Provider Screening and Enrollment portal instructions.

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February 9, 2023

Provider Basics
Enroll with MHCP

· Licensed marriage and family therapist (LMFT) Enrollment Criteria and Forms – Under Enrollment Criteria, we added Minnesota Provider Screening and Enrollment portal instructions.

· Physical Therapist Enrollment Criteria and Forms – Under Enrollment Criteria, we added Minnesota Provider Screening and Enrollment portal instructions.

· Speech-Language Pathologist Enrollment Criteria and Forms – Under Enrollment Criteria, we added Minnesota Provider Screening and Enrollment portal instructions.

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February 8, 2023

Mental Health Services

· Psychotherapy

· Under Authorization, we explained providers do not need to submit authorization requests for the following psychotherapy services that exceed unit or hour limits beginning Jan. 1, 2023, through Dec. 31, 2024:

· 26 hours psychotherapy (with patient) (including biofeedback) per calendar year, cumulative

· 26 units of family psychotherapy (with patient or family member or both), per calendar year, cumulative

· 10 sessions of multiple family group psychotherapy per calendar year

· 52 sessions of group psychotherapy per calendar year, cumulative

· Under Billing, we deleted CPT Code 99354 from the Mental health psychotherapy benefits for children and adults table as it has been discontinued.

Transportation Services

· Nonemergency Medical Transportation (NEMT) Services (Overview) – In the Noncovered Services section, under Excluded Costs Related to Transportation, we added information about not billing members for wait time.

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February 6, 2023

Provider Basics
Enroll with MHCP

· We have removed the County-contracted Mental Health Rehabilitation Enrollment Criteria and Forms page because we do not currently accept enrollment.

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January 27, 2023

Provider Basics
Enroll with MHCP

· Dental Therapist (DT), Advanced Dental Therapist (ADT), and Collaborative Practice Dental Hygienist (CPDH) Enrollment Criteria and Forms – Updated to clarify the enrollment process for these provider types.

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January 25, 2023

Certified Community Behavioral Health Clinic (CCBHC)

· Certified Community Behavioral Health Clinic (CCBHC) – We updated this manual section to reflect current Uniform Service Standards.

EW and AC

· Elderly Waiver (EW) and Alternative Care (AC) Program – Under the Elderly Waiver Customized Living Services Rate Adjustment section, we added a table for the minimum rate amount.

Mental Health Services

· Partial Hospitalization Program

· Under Eligible Providers, we updated to meet statutory requirements.

· Under Eligible Members, we removed SDQ as a screening tool for children and adolescents.

· Under Authorization Requirements, we removed SDQ.

Provider Basics
Enroll with MHCP

· Nursing Facility Enrollment Criteria and Forms

· We added a section on Conditions of Enrollment and provided legal citations for the authority on the requirements of participation with Minnesota Health Care Programs.

· We added a reference and link for Swing Bed Hospital Services for providers who want to enroll as swing bed services providers.

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January 24, 2023

HCBS Waiver Services

· HCBS Waiver Services – In the table in the Covered and Noncovered Services section, we updated Integrated community supports to be covered under BI, CAC, CADI and DD.

Provider Basics
Enroll with MHCP

· Chiropractor Enrollment Criteria and Forms – Group enrollment criteria is being changed to: To enroll as a chiropractic group, the chiropractic group must be composed of at least one enrolled chiropractor.

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January 23, 2023

Reproductive Health/OB-GYN

· Obstetric Services and HIV Counseling – Under Breast Pumps, we changed that E0602, manual breast pumps, and E0603, personal electric breast pumps, are covered one per pregnancy.

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January 20, 2023

Mental Health Services

· Adult Mental Health Targeted Case Management (AMH-TCM) and Children’s Mental Health Targeted Case Management (CMH-TCM)

· Under Mental Health Targeted Case Management: Core Service Components and Process, Assessment, we removed the Completing LOCUS assessment to determine resources and resource intensity needs requirement.

· Under Documentation, Client file, Documenting clinical supervision, we removed the Complete or cosign all members' level of care assessments LOCUS (adult MH-TCM only) requirement.

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January 18, 2023

Provider Basics
Billing Policy

· Billing the Member (Recipient) – Under Noncovered Services, we clarified the definition of a noncovered service.

· Payment Methodology - Non-Hospital – Under Legislative Changes Related to Rates, we updated dental information according to Minnesota Statutes 256B.76 and Minnesota Rules 9505.0445.

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January 13, 2023

Provider Basics
Enroll with MHCP

· Intensive Residential Treatment Services Enrollment Criteria and Forms – Under How to Enroll, we added MPSE information and updated the list of required documents.

· Licensed Professional Clinical Counselor Enrollment Criteria and Forms – Under Enrollment Criteria, we added Minnesota Provider Screening and Enrollment instructions.

· Occupational Therapist Enrollment Criteria and Forms – Under Enrollment Criteria, we have updated enrollment instructions to include the Minnesota Provider Screening and Enrollment portal.

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January 12, 2023

Provider Basics
Enroll with MHCP

· Billing Entity for Mental Health Enrollment Criteria and Forms – Under Enrollment Criteria, we updated information to include Minnesota Provider Screening and Enrollment instructions. We also explained children’s therapeutic services and supports (CTSS) and adult rehabilitative mental health services (ARHMS) providers must submit proof of fee payment and a copy of the CTSS or ARMHS certification letter.

Anesthesia Services

· Anesthesia Services – We added a table for the 2023 Anesthesia Rates in the section MHCP Anesthesia Payment Formulas.

Member Evidence of Coverage (EOC)

· MHCP Member Evidence of Coverage – Made small revision to the Child and Teen Checkups verbiage under the Covered Services heading.

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January 11, 2023

Reproductive Health/OB-GYN

· In the Minnesota Family Planning Program (MFPP) section of the MHCP Provider Manual, under Covered Services section, under Contraceptive and Medication Supplies, we removed the MFPP Contraceptive and Medication Supplies Table. We replaced it with the DHS NDC Search tool with instructions for use.

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January 10, 2023

Provider Basics
Enroll with MHCP

· Rural Health Clinic Enrollment Criteria and Forms – Under Enrollment Criteria, we added Minnesota Provider Screening and Enrollment instructions.

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January 9, 2023

Reproductive Health/OB-GYN

· Minnesota Family Planning Program (MFPP)

· In the Covered Services section, under Contraceptive and Medication Supplies, we removed the MFPP Contraceptive and Medication Supplies Table and replaced it with the DHS NDC Search tool with instructions for use.

· In the Legal References section, we removed the Section 1902(a)(32) of the Social Security Act reference and replaced it with the Code of Federal Regulations, title 42, section 435.214 reference.

Authorization

· MHCP Pharmacy Quick Reference

· We deleted the IFMC Medical Review Agent section because it is no longer valid.

· In the MHCP Provider Resource Center section, we deleted the check status of a medical supply authorization text because they do not check authorization requests.

· Additionally, updated the language for clarity.

Provider Basics
Enroll with MHCP

· Early Intensive Developmental and Behavioral Intervention (EIDBI) Provider Enrollment – Under Ongoing Reporting Requirements, we added a Changes in Ownership section, which includes a link to the Provider Entity Sale or Transfer Addendum (DHS-5550).

Substance Use Disorder (SUD) Services

· Substance Use Disorder (SUD) Services – Under Covered Services, we replaced smoking cessation with Tobacco Use Disorder cessation.

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January 6, 2023

Provider Basics
Enroll with MHCP

· Regional Treatment Center Enrollment Criteria and Forms – Under Enrollment Criteria, we added Minnesota Provider Screening and Enrollment instructions.

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January 5, 2023

Provider Basics
Enroll with MHCP

· Public Health Clinic Enrollment Criteria and Forms – Under Enrollment Criteria, we added Minnesota Provider Screening and Enrollment instructions.

Mental Health Services

· Dialectical Behavior Therapy Intensive Outpatient Program (DBT IOP)

· Under Eligible Members, we updated adolescent eligibility criteria.

· We updated assessment requirements and ITP requirements per legislation.

· We also updated this section to reflect Uniform Service Standards.

Transportation Services

· Local County or Tribal Agency Nonemergency Medical Transportation (NEMT) Services Claim, Service, and Rate Information – In the Personal and Volunteer Driver Mileage table, we updated 2023 IRS Mileage reimbursement rates. Rates have been increased to $0.65 per mile for codes A0090 UC Modifier for Licensed Foster Parent and A0080 Volunteer Driver.

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January 4, 2023

Equipment and Supplies

· Electrical Stimulation Devices – Under Covered Services, we deleted Implanted Neurostimulator Devices L8680 and L8686 and moved it to the Physician and Professional Services section of the MHCP Provider Manual.

Physician and Professional Services

· Physician and Professional Services

· We added the section Implantable Neurostimulators to clarify that the surgery CPT code 64568 requires prior authorization for the insertion of a cranial nerve neurostimulator electrode and generator. Claims for the devices will not pay unless there is an approved prior authorization for the procedure.

· Devices:

· L8680: Implantable neurostimulator, electrode, each

· L8686: Implantable neurostumulator pulse generator, single array, nonrechargable, includes extension

Provider Basics
Enroll with MHCP

· Podiatrist Enrollment Criteria and Forms – Under Enrollment Criteria, we added Minnesota Provider Screening and Enrollment instructions. We also added that a copy of the podiatry license must be submitted when enrolling.

· Optometrist Enrollment Criteria and Forms – Under Enrollment Criteria, we added Minnesota Provider Screening and Enrollment instructions. We also added that a copy of the optometry license must be submitted when enrolling.

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January 3, 2023

Reproductive Health/OB-GYN

· Abortion Services

· Under Eligible Members, we updated to include MinnesotaCare members.

· Under Legal References, we removed Minnesota Rules 9505.0235 (Abortion Services).

· Additionally, we updated the language for clarity.

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Previous 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