MHCP Provider Manual

Latest Manual Revisions

Revised: July 3, 2025

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.

July 3, 2025

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 Personal mileage codes and payment rates, we added the July 1, 2025, fuel adjuster for personal mileage codes S0215 (Mode 3) and S0215 (Mode 4).

· Under Personal mileage codes and payment rates for personal and volunteer drivers, we added the July 1, 2025, fuel adjuster for personal mileage codes Mode 1 A0090, Mode 1 A0090 and Mode 2 A0080.

· State-Administered Transportation Procedure Codes, Modifiers and Payment Rates – Under Transportation Procedure Codes, Modifiers and Payment Rates, we added July 1, 2025, fuel adjuster for procedure codes S0209, S0215 UA and T2049.

July 2, 2025

Equipment and Supplies

· Incontinence Products – Under the Covered Services heading, we clarified that incontinence products not used for incontinence must be listed on the MHCP incontinence products lists by HCPCS and manufacturer to be covered.

July 1, 2025

Provider Basics
Billing Policy

· Consolidated Provider Billing Information – This is a new manual page for billing information for a consolidated provider.

Equipment and Supplies

· Heat, Cold, and Light Therapy Devices and Services – We have published a new section of the Minnesota Health Care Programs (MHCP) Provider Manual for Heat, Cold, and Light Therapy Devices. MHCP covers these devices for members with a medical condition that requires application of heat, cold, or light.

· Mobility Devices – Under the Covered Services, Power-operated vehicles heading, we removed the ATP involvement as a requirement for power-operated vehicles (POVs). ATP involvement is required for ultralightweight and tilt-in-space manual wheelchairs and group 2 single-power-option wheelchairs and above.

· Nutritional Products and Related Supplies – Under the Covered Services, Human Donor Milk heading, we reduced the daily quantity limit for human donor milk (HCPCS T2101) from 32 units to 16. Authorization is required, except for the initial 30-day supply.

· The Seasonal Affective Disorder (SAD) Lights section of the Minnesota Health Care Programs Provider Manual has been removed. We have moved information from the SAD Lights section of the MHCP Provider Manual to the Heat, Cold and Light Therapy Devices and Services section of the MHCP Provider Manual.

· The Ultraviolet Light Therapy section of the Minnesota Health Care Programs Provider Manual has been removed. We have moved information from the Ultraviolet Light Therapy section of the MHCP Provider Manual to the Heat, Cold and Light Therapy Devices and Services section of the MHCP Provider Manual.

Individualized Education Program Services

· Speech and Language Pathology and Audiology

· We added information to reflect that effective July 1, 2025, a speech language pathology assistant (SLPA) who meets the requirements under Minnesota Statutes, 148.511 to 148.5198 and is licensed by the Minnesota Department of Health is eligible to provide services under the direction of a qualified Minnesota Health Care Programs enrolled speech language pathologist (SLP.) The changes include the following:

· Under Covered Services, we added two new sections – Supervising SLP Role and Responsibilities and Covered SLPA Services When Delegated by a Supervising SLP.

· Under Noncovered Services, we added information about what services are not covered when provided by a SLPA.

· We updated language for clarity.

Rehabilitative Services

· Rehabilitative Services

· Under the Eligible Providers heading, we added speech-language pathology assistants.

· Under the Rehabilitation Therapy Assistants heading, we added speech-language pathology assistants who meet the requirements under Minnesota Statutes 148.511 to 148.5198 and are licensed by the Minnesota Department of Health are eligible to provide services under the supervision of speech-language pathologists. We also added requirements for speech-language pathologists who are supervising speech-language pathology assistants.

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June 30, 2025

Enroll with MHCP

· Doula Enrollment Criteria and Forms – Under How to Enroll Doula – Individual, we added that enrollment applications must include a copy of the Minnesota Department of Health (MDH) Doula Registry letter. Additionally, we included details about when enrollment applications are returned to the applicant for more information. For reference, MDH no longer lists the start and end dates along with the individual name in their online doula registry so Minnesota Health Care Programs is unable to verify dates through the registry.

Physician and Professional Services

· Physician and Professional Services – Under Education and Counseling we removed tobacco cessation counselor as an authorized provider type to bill for tobacco cessation services.

June 27, 2025

Enroll with MHCP

· Community First Services and Supports (CFSS) Provider Agency Enrollment Criteria and Forms – We updated the questions and answers section. We updated the session dates and provided the link to register and attend the questions and answers sessions.

Equipment and Supplies

· Mobility Devices

· Under the Power-Operated Vehicles heading under Covered Services, we added a requirement that providers dispensing power-operated vehicles employ an Assistive Technology Professional certified by the Rehabilitative Engineering and Assistive Technology Society of America. The ATP must be directly involved in the device selection and fitting for the member.

· We added sections for definitions and legal references.

Nonemergency Medical Transportation (NEMT) Services

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

· Under Covered Services, Nursing Facility (NF) Members Approved for State-Administered NEMT Statewide:

· We added information about when to submit claims and how long providers have from the date of service to submit a claim.

· We removed information about if the county living arrangement is not updated three months after the month of admission because it no longer applies.

· We updated language for clarity.

June 20, 2025

Enroll with MHCP

· Home Health Enrollment Criteria and Forms – We deleted three bullet points from Home Health Agencies (HHAs) Providing Community First Services and Supports section:

· Designation of Billing Person for CFSS (DHS-8559) (PDF)

· Copy of certificate of registration with the Office of the Secretary of State of Minnesota

· Copy of Workers’ Compensation insurance

Nonemergency Medical Transportation (NEMT) Services

· State-Administered NEMT – We moved the Nursing Facility (NF) Members Approved for State-Administered NEMT Statewide section to be under the Overview section. Additionally, we also clarified language about submitting claims in this section.

June 18, 2025

Reproductive Health/OB-GYN

· Doula Services

· Under Covered Services, we removed outdated information from before May 1, 2024.

· Under Billing, we removed outdated billing information from before Jan. 1, 2024.

June 17, 2025

Equipment and Supplies

· Mobility Devices – MHCP changed authorization requirements for most manual wheelchairs. Under the Authorizations heading, we listed every device and accessory that requires authorization. We clarified providers should only include HCPCS codes on requests that require authorization always or for excess quantities.

June 16, 2025

Immunizations and Vaccinations

· Immunization and Vaccine Benefits Codes for Children – Under Vaccines and Toxoids Available Through MnVFC, we added CPT code 90623 and updated the age for CPT code 90707.

June 12, 2025

Equipment and Supplies

· Orthotics and Prosthetics – Under the Covered Services heading, Lower Limb Orthoses, we added criteria for custom-fabricated knee-ankle-foot orthoses (KAFOs) with automatic lock and swing-phase release (HCPCS L2005) and microprocessor-controlled KAFOs (HCPCS L2006).

June 11, 2025

Provider Basics
Provider Requirements

· Provider Screening Requirements – We added the revalidation dates for June through August 2025 in the Revalidation Schedule Table.

June 10, 2025

Laboratory and Pathology Services

· Laboratory and Pathology Services – Under Genetic Testing under the Billing heading, we added information about pharmacogenetic testing. We stated genetic testing and germline testing are not medically reasonable and necessary.

June 6, 2025

Personal Care Assistance (PCA) Services

· Personal Care Assistance (PCA) Services – We added the section Tiered Rates and Wage Floors with information about tiered rates and minimum wage information for PCA agencies and PCA Choice. We updated language in the Managed Care Members section to clarify that ages 65 and younger are carved out of managed care organization coverage.

June 5, 2025

Community First Services and Supports

· Community First Services and Supports (CFSS)

· We added a Tiered Reimbursement Rates for Community First Services and Supports (CFSS) Agency Model section and a Tiered Minimum Wages for CFSS Budget Model section to explain reimbursement and wage tiers for CFSS workers.

· We also clarified the Managed Care Members section.

· We made updates to language and policy links throughout the webpage.

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May 29, 2025

Mental Health Services

· Certified Peer Specialist Services – Under the Eligible Providers heading, we added Certified Community Behavioral Health Centers and removed the age requirement.

Rehabilitation Services

· Rehabilitative Services

· We changed plan of care to plan of treatment throughout this manual section.

· Under the Plan of treatment heading, we clarified that the plan of treatment requirements for all rehabilitation services must be reviewed and revised by the member's attending physician or licensed practitioner of healing arts per Medicare requirements.

May 28, 2025

Dental Services

· Dental Benefits – Under Overview, we added new information defining service limit, one service per year, two services per year and calendar year.

May 23, 2025

Mental Health Services

· Adult Rehabilitative Mental Health Services (ARMHS) – Under the Eligible Providers heading, we removed language requiring providers to seek local or county approval for certification.

· Children’s Mental Health Residential Treatment, 3rd Path/Children’s Mental Health Residential Services Path and Institution for Mental Disease

· Under the Eligible Members heading, we added information about 3rd Path participants.

· We added sections for Covered Services, Level of Care Determination, and Discharge Transition.

· Under Billing, we clarified information for counties and tribes. We also added a Description of codes and units table.

May 22, 2025

Physician and Professional Services

· Physician and Professional Services – In the Genetic Counselor or Geneticist section, we updated the code for consultations provided by a genetic counselor to 96041. The code 96040 is no longer used.

May 20, 2025

Equipment and Supplies

· Patient Lifts and Seat Lift Mechanisms – Under Noncovered Services, we added Hoyer converters.

May 16, 2025

Provider Requirements

· Access Services

· Under Covered Services, we updated the hyperlink to managed care organizations.

· Under Limited English Proficiency (LEP), we updated the hyperlink to Guidance to Federal Financial Assistance Members Regarding Title VI Prohibition Against National Origin Discrimination Affecting Limited English Proficient Persons.

· We updated language for clarity.

May 15, 2025

Individualized Education Program Services

· Covered and Noncovered Services IEP Health-Related Services – Under Covered IEP Health-Related Services, Services Not Covered by IEP Funding, we changed the second listed item to "Services for a student after they reach age 22 (or graduated from high school, whichever comes first.)."

May 14, 2025

Mental Health

· Youth Assertive Community Treatment (Youth ACT)/Intensive Rehabilitative Mental Health Services (IRMHS) – Under the Billing heading, we added a link to the 2025 Intensive Rehabilitative Mental Health Services - Rates Approved by DHS - Behavioral Health Division.

May 13, 2025

Provider Basics
Provider Requirements

· Provider Screening Requirements – We updated the Revalidation section of this manual page to clarify where providers can get a list of required documents for the revalidation process.

May 9, 2025

Hospice Services

· Hospice Services

· Under the Physician Services heading, we specified claims submitted for adult hospice services need to use the appropriate diagnosis code that identifies the reason for the treatment, service or item, not the diagnosis code for the terminal illness.

· Under the Hospice Payments and Limits heading, we added information about base rates and legislative add-ons or reductions.

May 5, 2025

Equipment and Supplies

· Orthotics and Prosthetics

· Under the Breast Prosthetics heading in the Covered Services section, we clarified that breast prosthetics are covered post-mastectomy or for conditions which result in absence or defect of the breast.

· Under the Authorization heading, we added HCPCS L2005.

· Pressure Reducing Support Surfaces – We made formatting and structural edits throughout this manual section. There is no change in policy.

May 2, 2025

Equipment and Supplies

· Positioning Equipment – We made formatting and structural edits throughout this manual section. There is no change to policy.

May 1, 2025

Enroll with MHCP

· Early Intensive Developmental and Behavioral Intervention (EIDBI) Provider Enrollment Criteria and Forms – We added a Risk Level for EIDBI Provider Agencies section that explains all new EIDBI provider agency enrollments, reenrollments, and ownership change requests submitted on or after June 1, 2025, will be screened at the high-risk level.

· Housing Stabilization Services Enrollment Criteria and Forms – We added a Risk Level section that explains all new Housing Stabilization Services enrollments, reenrollments, and ownership change requests submitted on or after June 1, 2025, will be screened at the high-risk level.

Provider Basics
Provider Requirements

· Risk Levels and Enrollment Verification Requirements – We have changed the risk level for EI EIDBI - Agency from moderate to high effective June 1, 2025. We also added a row for 18 Housing Stabilization Services and placed it in high risk effective June 1, 2025.

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April 30, 2025

Provider Basics

· Managed Care Organizations (MCOs) – In the Carve-out Services section, we separated personal care assistance (PCA) and health care nursing into separate bullets for clarity. We added Community First Services and Supports to the bullet with PCA information. We clarified the language in both bullets to include members 64 and younger and members on Special Needs BasicCare and Medical Assistance for Families and Children.

April 28, 2025

Enroll with MHCP

· Substance Use Disorder (SUD) Services Enrollment Criteria and Forms – We have removed the incorrect DAANES phone number and added the DAANES contact email address: dhs.daanes@state.mn.us.

April 25, 2025

Equipment and Supplies

· Mobility Devices – Under the Wheelchair Options and Accessories heading in the Covered Services section, we added criteria for retractable or removable mounting hardware and transportation and transit securement systems.

· Pneumatic and Nonpneumatic Compression Devices – Under the Authorization heading, we updated to allow capped rental periods or purchases with authorization for nonpneumatic compressors and appliances.

· Urological and Bowel Supplies – Under the Irrigation Supplies heading and the Authorization thresholds for urological supplies table in the Covered Services section, we updated the quantity limit to 62 per month for HCPCS codes A4320 and A4322.

Mental Health Services

· Adult Day Treatment

· Under the Eligible Providers heading, we added language for accreditation.

· Under the Admission Criteria heading in the Eligible Members section, we revised information about the Individual Treatment Plan.

· Under the Covered Services heading, we removed the two-hour per week maximum limit for group psychotherapy.

· Psychotherapy – Under the Progress Notes heading in the Documentation of Covered Services section, we added progress notes must include a staff person’s plan to take future actions, including changes if intervention was ineffective.

April 23, 2025

Dental Services

· Dental Authorization Requirement Tables

· Under Overview, we added that all services requested must be medically necessary and cost effective.

· Under Implant Services, we added that specific syndrome or conditions do not pre-qualify a member for implant approval. We also updated language for clarity.

Early Intensive Developmental and Behavioral Intervention

· Early Intensive Developmental and Behavioral Intervention (EIDBI) Managed Care Organization (MCO) Contact Information Grid – In the United Healthcare column, we noted United Healthcare's contract with Minnesota Department of Human Services ended Dec. 31, 2024.

Equipment and Supplies

· Breast Pumps – In the Breast Pump Supplies chart under the Covered Services heading, we clarified quantity limits for breast pump replacement parts.

· Orthotics and Prosthetics – Under Covered Services, the Upper Limb Prostheses heading, we added coverage information for prosthetic sheaths, shrinkers, and socks.

Waiver and Alternative Care (AC) Program

· Elderly Waiver (EW) and Alternative Care (AC) Program – We added information for Community First Services and Supports (CFSS). We added transitional services to the Alternative Care program. We removed the bookmarks for Covered Services at the top of the page so that the links appear only in the Covered Services table.

April 22, 2025

Dental Services

· Dental Benefits – Under Implant Services, we added CDT codes and service limits for D6010 – D6050, D6080, D6081, D6180, D6090, D6092, D6093 and D6199.

April 21, 2025

Equipment and Supplies

· Surgical Dressings – Under the Billing heading, we added information about dressings for kits and billing additional units.

Provider Basics

· Authorization – Under the Substance Use Disorder Request for Nonresidential (outpatient) Group and Individual Treatment heading, we deleted duplicative medical review agent timeline information.

April 18, 2025

Early Intensive Developmental and Behavioral Intervention

· Early Intensive Developmental and Behavioral Intervention (EIDBI) Managed Care Organization (MCO) Contact Information Grid – We updated information in the UCare, IMCare, HealthPartners and Prime West columns.

Nonemergency Medical Transportation (NEMT) Services

· Protected Transportation Services – Under Overview, we updated that the Protected Transport - Level-of-assessment (LOS) Assessment (DHS-6715) can be faxed or uploaded to the medical review agent provider portal. Emailed forms are no longer accepted.

April 17, 2025

Equipment and Supplies

· Mobility Devices – Under the Covered Services heading, Manual Wheelchairs, we added information about requiring Assistive Technology Professional in-person involvement in selecting ultra-lightweight (K0005) and tilt-in-space (E1161) manual wheelchairs for the member.

· Orthotics and Prosthetics

· Under Covered Services heading, we added information on prosthetics for breasts, eyes, and faces.

· We added a Legal References section.

Provider Basics
Provider Requirements

· Risk Levels and Enrollment Verification Requirements – We added a row to the table for 38 CFSS Community First Services and Supports.

School-Based Community Services

· School-Based Community Services (SBCS) – Under Overview, we added the school-based community services can be billed to fee-for-service or managed care organizations.

April 15, 2025

Enroll with MHCP

· Recovery Community Organization (RCO) Enrollment and Forms

· We updated and clarified language about peer recovery support services in the opening paragraph.

· We added a Filing an Appeal to Minnesota Department of Human Services (DHS) section to include information about the appeal process.

· Under the Revalidation heading, we clarified revalidation information.

· Under the Legal References, we updated the list of legal references.

April 11, 2025

Equipment and Supplies

· Equipment and Supplies – We have added a link to the new Surgical Dressings section of the Minnesota Health Care Programs Provider Manual.

· Surgical Dressings – We have published a new section of the Minnesota Health Care Programs Provider Manual.

Substance Use Disorder Services

· Substance Use Disorder (SUD) Services – Under the Eligible Providers heading, we clarified providers are required by Minnesota Statutes, 254B.05, subdivision 1b. (3) to enroll and participate in the Drug and Alcohol Abuse Normative Evaluation System (DAANES).

· Substance Use Disorder (SUD) Withdrawal Management Services – Under the Billing heading, we removed the following: For behavioral health fund authorized services, a county or tribe generated service agreement is not a requirement to bill MHCP. Providers create daily encounters using the Drug and Alcohol Abuse Normative Evaluation System (DAANES) Detox/ Withdrawal Management system to create records for members to enable direct billing without a service agreement. Providers will then submit the claims through MN-ITS.

April 8, 2025

Health Care Programs and Services

· MHCP Benefits at-a-glance – We removed Program JJ from the Benefits at-a-glance table. We added Community First Services and Supports, Consumer Directed Community Supports, Consumer Support Grant and Recuperative Care in the MHCP Benefits at-a-glance table.

Reproductive Health/OB-GYN

· Obstetric Services – Under Billing, Billing for Enhanced Services, we added certified professional midwives (CPM) to the table of providers who are able to provide enhanced services for high-risk pregnancies (HCPCS Codes H1001 - H1004).

April 7, 2025

Nonemergency Medical Transportation (NEMT) Services

· Nonemergency Medical Transportation (NEMT) Services (Overview)

· Under Authorization Requirements we added information regarding Mode 4 to the Types of transports requiring authorization table.

· We updated language for clarity.

April 4, 2025

Nonemergency Medical Transportation (NEMT) Services

· Access Services Ancillary to Transportation

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

· Under the Overview, Eligible Providers, Covered Services, and Billing sections, we clarified language to reflect guideline updates.

· Under Authorization Requirements, we added requirement details.

April 2, 2025

Equipment and Supplies

· Pneumatic and Nonpneumatic Compression Devices – MHCP added information about gradient compression garments, stockings, and bandaging supplies under the Overview and Covered Services headings.

Nonemergency Medical Transportation (NEMT) Services

· State-Administered Transportation Procedure Codes, Modifiers and Payment Rates – Under the Transportation Procedure Codes, Modifiers and Payment Rates heading, we updated quarterly fuel adjustments for Apr. 1, 2025.

April 1, 2025

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 the Overview heading, we added the member contact phone number for the medical review agent for Mode 4 assessment.

· Under the MTM-MNET, SmartLink and Local County or Tribal Agency-Administered Transportation Personal Mileage Codes, Modifiers and Payment Rates heading, we updated the quarterly IRS mileage rates for Jan. 1, 2025.

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March 31, 2025

Equipment and Supplies

· Mechanical Stretching Devices – Under the Noncovered Services heading, we updated to include HCPCS E1832.

· Respiratory Equipment – Under the Covered Services heading, we added criteria for dual-function ventilators and clarified which devices are included in payment for the dual- and multifunction ventilators.

· Urological and Bowel Supplies – Under the Covered Services and Authorization headings, we updated the policy for anal irrigation catheters (code A4453).

Provider Basics
Provider Requirements

· Excluded Provider Lists – Under the Minnesota Excluded Providers heading, we added a field for Exclusion Status.

March 28, 2025

Enroll with MHCP

· Community First Services and Supports (CFSS) Provider Agency Enrollment Criteria and Forms – Removing expired information and replacing with current.

March 25, 2025

Equipment and Supplies

· Orthotics and Prosthetics

· Under the Covered Services heading, we added coverage criteria for upper limb prostheses (codes L6000-L7259, L7400-L7499, L8701, L8702) and batteries and chargers (L7360-L7368).

· Under the Noncovered Services heading, we clarified that any repair or replacement costs are not covered for 90 days after the date of delivery.

· Under the Authorization heading, we added the following as requiring authorization:

· Transcarpal/metacarpal or partial hand disarticulation prosthesis (L6026)

· Interscapular thoracic prosthetics (L6350, L6360, L6370)

· Molded socket endoskeletal systems (L6400-L6570)

· Certain terminal devices and additions (L6715, L6880, L6881)

· External power upper limb prosthetics (L6920-L6975)

· Electronic elbow additions (L7170-L7259)

March 21, 2025

Equipment and Supplies

· Hospital Beds – Under Covered Services, the Enclosed beds heading, we clarified that therapist evaluations are required for enclosed beds and accessories.

· Mobility Devices – Under the Power Wheelchair heading under Covered Services, we added that MHCP now requires providers dispensing Group 2 single-power-option wheelchairs or any multiple-power wheelchairs to employ an Assistive Technology Professional (ATP) certified by the Rehabilitative Engineering and Assistive Technology Society of America. The ATP must be directly involved in the wheelchair selection and fitting for the member.

March 20, 2025

Provider Basics
Provider Requirements

· Access Services – Under Language Interpreter Services, Eligible Members, we updated benefit set KK to include expanded for children age 19 years and under; updated benefit set LL to include expanded for children under age 19; and added benefit set XX to the table. We made these changes so the listing is consistent with MHCP Benefits at-a-Glance.

March 19, 2025

Home Care Services

· Home Health Aide Services

· We added a new Overview section and listed additional enrolled Minnesota Health Care Programs (MHCP) providers who are allowed to order Home Health Aide services.

· Under Authorization Requirements and Assessments, we added additional MHCP providers who are allowed to order Home Health Aide services.

· Under Legal References, we removed hyperlinks for Code of Federal Regulations, title 42, sections 440.70 and 484.36. We added a new hyperlink for Code of Federal Regulations, title 42, section 440.70.

· We updated language for clarity.

Immunizations and Vaccinations

· Immunization and Vaccine Benefits Codes for Children

· Under Seasonal Respiratory Illness Vaccines, we added an asterik for CPT Code 90674 to show is it not available through MnVFC.

· Under Seasonal Respiratory Illness Vaccines, we added trivalent to CPT Codes 90660 and 90661.

Officer-Involved Community-Based Care Coordination Services

· Officer-Involved Community-Based Care Coordination

· Under Limitations under the Covered Services heading, we updated guidance to read:

· Members may only receive up to 80 hours of service in a 60-day period once per calendar year.

· The 60-day period begins the first day service is provided.

· Under the Billing heading, we corrected to instruct submitting claims electronically using MN–ITS 837P.

March 19, 2025

Immunizations and Vaccinations

· Immunizations and Vaccinations

· Under Billing, Billing for Child Vaccines, we clarified CPT Administration Code 96380 (RSV) is only for the RSV monoclonal antibody product.

· Under Billing, Billing for Adult and Non MnVFC Vaccines, we removed CPT Administration Codes 90380 and 90381.

Individualized Education Program Services

· Covered and Noncovered Services IEP Health-Related Services – Under Telehealth Services for IEP, Covered Telehealth Services, we added mental health services.

March 13, 2025

Enroll with MHCP

· Early Intensive Developmental and Behavioral Intervention (EIDBI) Provider Enrollment Criteria and Forms – We added information about licensed behavior analysts (LBA) enrolling as qualified supervising professionals (QSP).

Reproductive Health/OB-GYN

· Abortion Services – Under Billing, Abortion-Related Services, we updated the requirements for when the Medical Necessity Statement (DHS-2327) needs to be submitted with the claim. We also removed information about Healthcare Common Procedure Coding System codes S0190 and S0191 and billing for the treatment of incomplete legally induced abortions for clarity.

March 12, 2025

Equipment and Supplies

· Standers – In the Authorization Request section, we clarified the trial period for standers is a minimum of three days.

March 10, 2025

Billing Policy

· Payment Methodology - Non-Hospital

· Under Rate Variations and Legislative Changes, Legislative Changes Related to Rates, we added new legislation changes about payment rates for behavioral health services included in the MHCP Fee-for-Service Outpatient Services Rate Study.

· Under Mental Health Services, we updated information to reflect new legislation changes about mental health services reimbursed under the resource-based relative value scale (RBRVS).

· Under Physician, we updated the RBRVS rate.

Equipment and Supplies

· Mobility Devices – We added information for mobile arm supports and additions in the Wheelchair Options and Accessories section. MHCP now requires authorization and covers these items for positioning support and performing activities of daily living.

March 6, 2025

Equipment and Supplies

· Equipment and Supplies – Under the Miscellaneous Products heading, we added information about blood pressure monitoring devices.

· Orthotics and Prosthetics

· Under Covered Services, the Devices for Bathing and Recreation heading, we added language for reasonable use lifetime for artificial limbs.

· Under the Authorization heading, we updated authorization requirements. MHCP covers the member's initial devices for everyday use and bathing without authorization, unless the individual HCPCS requires authorization, or the member already has multiple devices. Recreational devices and new subsequent devices for any purpose do require authorization.

Mental Health Services

· Children’s Intensive Behavioral Health Services (CIBHS)

· We removed level of care 4 language from multiple sections to address statute changes that removed the requirement to use the CASII/ECSII for assessment tools.

· Under the Provider Responsibilities heading, we clarified best practices for family involvement in services and updated the medical necessity language to more closely align with statute and clarify requirements.

· Under the CIBHS Certification Process heading, we added a link to the certification process.

· Under the Covered Services heading, we removed Trauma Focused Cognitive Behavioral Therapy and Trauma Informed Child Parent Psychotherapy training requirements for clinical trainees.

· Youth Assertive Community Treatment (Youth ACT)/Intensive Rehabilitative Mental Health Services (IRMHS)

· Under the Eligible Providers heading, we removed the memorandum of understanding with counties requirement because it is no longer required. We also updated licensed alcohol and drug counselor with co-occurring disorder specialist to align with legislative changes. Also updated substance use and co-occurring specialist language throughout document.

· We added a new Certification and Contract Process section to align with statute. The section includes a link to the contracting and certification process.

· We updated level of care and functional assessment language throughout document to align with statute.

· Under the Authorization heading, we updated the authorization unit requirements. We changed units from 75 to 156 to align with current process standards.

March 4, 2025

Equipment and Supplies

· Positive Airway Pressure for Treatment of Obstructive Sleep Apnea – Under the Member Compliance heading, we added information about Advanced Recipient Notices (ARNs).

March 1, 2025

Reproductive Health/OB-GYN

· Family Planning

· Under Covered Services, we added sexually transmitted infections prevention techniques.

· Under Billing, we removed all coding specific content. Providers should bill the appropriate code for the services or medications provided.

· We updated some policy language for clarity.

· Minnesota Family Planning Program (MFPP)

· Under Covered Services, we removed the Minnesota Family Planning Program (MFPP) Healthcare Common Procedure Coding System (HCPCS) Codes document because it is outdated. Family planning services and codes are covered when they meet policy criteria.

· Under Covered Services, Contraceptive and Medication Supplies, we removed language for specific billing codes from billing policy. Providers should bill the appropriate codes for the services provided.

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February 27, 2025

Pharmacy Services

· 340B Drug Pricing Program – Under Billing, 340B-Covered Entities, we added the JG and TB modifiers for when providers should submit clinic-administered claims to a managed care organization.

February 26, 2025

Equipment and Supplies

· Positive Airway Pressure for Treatment of Obstructive Sleep Apnea – Under the Covered Services heading, we added information about rentals for BiPAP devices with backup rate for members with obstructive sleep apnea and coexisting breathing disorders.

February 25, 2025

Equipment and Supplies

· Ambulatory Assist Equipment – Under the Noncovered Services heading, we added powered walkers because they are considered investigative.

· Respiratory Equipment – Under the Covered Services heading, we added information for dual-function ventilators and respiratory equipment supply codes.

Hospital Services

· Inpatient Hospital Services – Under Eligible Members, Incarcerated Member's Eligibility, we clarified managed care organizations are not responsible for covered services when a member is incarcerated. Additionally, we clarified details about submitting claims for inpatient stay cost; and when a correctional facility is responsible for inpatient stay cost.

February 24, 2025

Dental Services

· Dental Services – Under Teledentistry Services, we added CDT codes D1310, D1320 and D1330.

February 18, 2025

Enroll with MHCP

· Optical Company Enrollment Criteria and Forms – We created the Optical Company Enrollment Criteria and Forms section to guide providers on how to enroll as an Optical Company with Minnesota Health Care Programs.

February 13, 2025

Equipment and Supplies

· Airway Clearance Devices – Under the Covered Services heading, we added information about replacement parts.

February 10, 2025

Enroll with MHCP

· Direct Support Worker (DSW), Individual Enrollment Criteria and Forms – We updated the required direct support worker Community First Services and Supports (CFSS) forms.

· Targeted Case Management (TCM) Enrollment Criteria and Forms – Under the Online MPSE Portal heading, we explained targeted case management services can be added to multiple enrollment record types using MPSE. We also added a chart showing which provider types may enroll to provide each targeted case management service.

Equipment and Supplies

· Pneumatic and Nonpneumatic Compression Devices – We have updated this manual section throughout to include information about nonpneumatic compression devices. We expanded compression devices policy to include nonpneumatic items, including compressors and appliances and nonsequential peristaltic wave compression pumps.

Individualized Education Program Services

· Rates and Payments – We added hyperlinks to the main content sections on the top of the page.

Recuperative Care

· Recuperative Care

· Under Eligible Providers – Health Services, we changed the Supervising Recuperative Care Health Services section title to Advanced Practice Provider for Recuperative Care Health Services.

· Under Eligible Providers – Health Services, Providing Recuperative Care Health Services, we clarified information for community health workers.

· Under Billing, Recuperative Care Health Services Rate, we clarified billing information if members have both Medicare and Medical Assistance coverage.

· Under Billing, Recuperative Care Health Services Claim (Professional Claim), we clarified information for reporting the enrolled MHCP MD, PA or APRN NPI as the rendering provider who is supervising health services.

· Under Billing, we added information about documentation.

February 7, 2025

Equipment and Supplies

· Equipment and Supplies – Under the Covered Services heading, Miscellaneous Products, we added information about protective helmets.

Immunizations and Vaccinations

· Immunization and Vaccine Benefits Codes for Children – Under Vaccines and Toxoids Available through MnVFC, we removed CPT codes 90622, 90670, 90672, 90674, 90686, 90687, 90688 and 90792.

Transportation Services

· State-Administered NEMT

· Under Overview, we changed Kepro to medical review agent and updated with new phone number for members to call and get a level of service assessment.

· We changed Kepro to medical review agent throughout the page.

February 6, 2025

Dental Services

· Dental Authorization Requirement Tables – For impacted teeth, we added prior authorization requirements for coronectomy, and clarified language for radiographs. We added CDT code D7252 to the list of CDT codes for impacted teeth, and added CDT codes D8091 and D8671 to list of orthodontic CDT codes.

February 3, 2025

Dental Services

· Dental Services – Under the Teledentistry Services, List of Teledentistry Services, we added CDT Code D0273 - bite wings three radiographic images.

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January 31, 2025

Equipment and Supplies

· Nutritional Products and Related Supplies – Under the Authorization Requirements heading, we clarified that all authorization requests for enteral nutritional products must have a treatment plan performed by a nutritionist, speech-language pathologist, or other provider in their scope of practice.

Substance Use Disorder Services

· Substance Use Disorder (SUD) Withdrawal Management Services

· Under the Overview heading, we added clarification to the:

· Level 3.2 Clinically Managed Program section to include a comprehensive assessment according to Minnesota Statutes, 245G.05 and access to medications administered by licensed staff trained to manage withdrawal.

· Level 3.7 Medically Monitored Program section to explain a registered nurse must be on site 24 hours a day and a qualified medical professional must be available every day. Patients must be able to see a qualified medical professional within 24 hours if needed. We included information that patients admitted to this level of care receive medical observation, evaluation, stabilization treatment services, a comprehensive assessment according to Minnesota Statutes, 245G.05 and access to medications administered by licensed staff trained to manage withdrawal.

· Under the Eligible Providers heading, we:

· added applicable tribal license

· added ASAM Certification link

· added email for DHS.DAANES@state.mn.us

· removed chemical dependency licensed treatment facilities, detox providers, tribally licensed programs, hospital-based programs, Intensive Residential Treatment Services facilities and mental health crisis facilities

· Under the Eligible Members heading, we added individuals seeking eligibility for services through Behavioral Health Fund (BHF) must complete the Behavioral Health Fund Request (DHS-2780A) and submit the application to the individual's county of financial responsibility as defined in Minnesota Statutes, 256B.02, subdivision 4.

· Under the Noncovered Services heading, we:

· replaced Rule 25 chemical use assessment with comprehensive assessments

· included Substance Use Disorder Medications for Opioid Use Disorder (SUD-MOUD) , SUD-MOUD - methadone, SUD-MOUD - other, SUD-MOUD - methadone-plus, and SUD-MOUD - other- plus

· We added a Utilization Management section.

January 29, 2025

Dental Services

· Dental Benefits

· Under Covered Services,

· Diagnostic, Clinical Oral Evaluations, we updated the description for CDT Code D0160 in the table. We also added CDT Code D0170 to the table.

· Prosthodontics, we clarified the service limits for CDT Codes D5410-D5422 and D5511-D5520 in the table.

· Oral and Maxillofacial Surgery, we added CDT Code 7252 to the table.

· Orthodontics, All MHCP Orthodontia Programs, we added CDT Codes D8091 and D8671 to the table.

· Adjunctive General Services, we added CDT Code D9243 to the same row as D9222 in the table. We also placed CDT Code D9248 in its own row.

· Under Billing, Orthodontic Billing, Non-comprehensive orthodontic treatment, we added information about comprehensive orthodontic treatment in association with orthognathic surgery.

January 28, 2025

Enroll with MHCP

· Child and Teen Checkups (C&TC) Enrollment Criteria and Forms

· We updated the title of this page to "Child & Teen Checkups (C&TC) Enrollment Criteria and Forms".

· Under the Online MPSE Portal heading, we clarified documents that need to be uploaded if enrolling using the MPSE portal and who can enroll as a C&TC clinic.

· Under the Submit Forms via Fax heading, we clarified documents that need to be faxed to MHCP and who can enroll as a C&TC clinic.

· Under the Additional Resources heading, we removed repealed statutes.

January 27, 2025

Enroll with MHCP

· Home and Community-Based Services (HCBS) Programs Provider Enrollment Criteria and Forms – We clarified the text in the Waiver and AC Resources and MN-ITS Training section and in the HCBS Waiver and AC Provider Training 101 Proof of Completion section.

Substance Use Disorder Services

· Telehealth Delivery of Substance Use Disorder Services – Under the Legal References heading, we removed reference to a repealed rule and added relevant statutory reference.

January 23, 2025

Individualized Education Program Services

· Covered and Noncovered Services IEP Health-Related Services

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

· Under Initial Evaluations, Reevaluations and Health-Related Assessments, Covered Health-Related Components of an IEP Evaluation or Reevaluation, we added information for indirect minutes.

· Under Covered IEP Health-Related Services, Coverage Criteria for all IEP Health-Related Services and Services Not Covered by IEP Funding, we updated the age of the child to 22.

· We updated language for clarity.

· Physical Therapy Services

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

· Under Covered Services, we clarified that face-to-face assessments can be held in person or virtually.

January 22, 2025

Provider Basics
Billing Policy

· Payment Methodology - Non-Hospital – Under the Rate Variations and Legislative Changes, Legislative Changes Related to Rates heading, we added the legislative rate decrease schedule for critical access mental health services.

January 21, 2025

Mental Health Services

· Adult Residential Crisis Stabilization Services (RCS) – Under the Eligible Providers heading, we added a note clarifying both the licensing and MHCP rate setting processes must be completed before enrollment.

January 17, 2025

Provider Basics
Billing Policy

· Billing the Member (Recipient) – We added a 2025 Fee-for-Service Copays table and a 2025 Family Deductible table for Medical Assistance and MinnesotaCare.

January 16, 2025

Enroll with MHCP

· Community First Services and Supports (CFSS) Provider Agency Enrollment Criteria and Forms – We added a link to a detailed guide for how to add CFSS to an enrollment record due for revalidation to the Revalidation section of this page.

Equipment and Supplies

· Breast Pumps – Under the Covered Services heading, we clarified quantity limits for breast pump replacement parts in the HCPCS codes, definitions, and limits for MHCP-covered breast pump supplies chart. Only one unit per HCPCS code is allowed per dispensing. Two replacement parts are covered per year before authorization is required.

· Equipment and Supplies – We have added a link to the new Mechanical Stretching Devices section of the MHCP Provider Manual.

· We have added a Mechanical Stretching Devices section to the Minnesota Health Care Programs (MHCP) Provider Manual. MHCP covers dynamic splinting systems with authorization to treat joint contractures. MHCP does not cover static progressive stretch or patient-actuated serial stretch devices.

· Mobility Devices – Under the Billing heading, we updated to state we now reimburse wheelchair accessory codes with the KE modifier. KE modifier rates are eligible beginning Jan. 1, 2025. The KE Modifier Rural Price List is available on the Equipment and Supplies Resources webpage. MHCP policy only allows one pricing modifier per accessory.

Individualized Education Program Services

· Speech and Language Pathology and Audiology

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

· We changed the “Qualified Service Providers" section title to “Eligible Providers."

Substance Use Disorder Services

· Substance Use Disorder (SUD) Services

· Under the Billing, Managed Care Organization (MCO) Enrollees heading, we clarified treatment and room and board services billing for MinnesotaCare members enrolled in an MCO.

· We also added an MA members enrolled in MCO section and included a link to the Value Code 24 MCO Room and Board Billing (PDF).

January 14, 2025

Provider Basics
Provider Requirements

· Past Revalidation Schedule – We moved some of the previous revalidation dates from the Provider Screening Requirements manual page to the Past Revalidation Schedule table.

· Provider Screening Requirements – We added updated information for revalidation dates for provider types to the current Revalidation Schedule table and moved some of the previous revalidation dates to the Past Revalidation Schedule.

January 13, 2025

Individualized Education Program Services

· Children’s Therapeutic Services and Supports (CTSS) IEP Services Provided in School – We added a new Resources section that includes a hyperlink to the Minnesota Health Care Programs acronyms webpage.

· Mental Health CTSS Definitions and Acronyms – We removed this page because we added a hyperlink to the Minnesota Health Care Programs acronyms webpage on the Children's Therapeutic Services and Supports (CTSS) IEP Services Provided in School page.

January 10, 2025

Pharmacy Services

· Pharmacy Services

· Under Overview, How to Determine Drug Coverage, we updated the hyperlink for the Drug Lookup tool.

· Under Covered Services, Pharmacist Prescribing - OTC Medications, we updated the hyperlink for the Drug Lookup tool.

January 9, 2025

Individualized Education Program Services

· Individual Education Program (IEP) Services Providers

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

· Under Provider Responsibilities, Electronic Funds Transfer, we updated the hyperlinks for the Minnesota Supplier Portal and EFT Bank Change Request.

· Under Provider Information and Resources:

· MHCP Provider Resource Center, we updated the selection options.

· DHS IEP Services Contacts, we updated policy and rates contact information.

· We updated language for clarity.

January 8, 2025

Individualized Education Program (IEP) Services

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

Immunizations and Vaccinations

· Immunizations and Vaccinations – Under Billing for Adult Vaccines and Non MnVFC Vaccines, we updated RSV administration code 96380 by removing language "with counseling if obtained through MnVFC" and 96381 by removing "without counseling if obtained through MnVFC."

Mental Health Services

· Intensive Residential Treatment Services (IRTS) – Under the Eligible Providers heading, we added a note clarifying both the licensing and MHCP rate setting processes must be completed before enrollment.

January 7, 2025

Enroll with MHCP

· Community First Services and Supports (CFSS) Provider Agency Enrollment Criteria and Forms – We added a section to explain the CFSS weekly Questions and Answers sessions and add the link to join the sessions.

· Substance Use Disorder (SUD) Services Enrollment Criteria and Forms – We changed the 1115 Substance Use Disorder System Reform Demonstration heading to Certifying an ASAM Level of Care. Under that new heading, we updated language for substance use disorder providers to enroll with MHCP based on legislative changes, incorporating ASAM levels of care into Minnesota Statutes.

Substance Use Disorder Services

· Substance Use Disorder (SUD) Services

· We removed references to the 1115 Substance Use Disorder (SUD) System Reform Demonstration waiver to align language with recently approved state plan pages that adopted ASAM levels of care and removed 1115 Waiver Base Rate enhancement.

· We removed 1115 SUD System Reform Demonstration information from under the Overview heading.

· Under the Eligible Providers heading, we:

· Added ASAM level of care 3.1, 3.3, and 3.5 to Licensed residential SUD treatment programs.

· Added ASAM levels of care 1.0, 2.1, and 2.5 to Licensed nonresidential (outpatient) SUD treatment programs.

· Removed 1115 SUD System Reform Demonstration information.

· Added a new section called ASAM Certification and included the following:

· ASAM Certification Checklist (DHS-7325) and Outpatient Behavioral Health Fund (BHF) Service Request (DHS-6382), and Behavioral Health Fund Provider Assurance Statement (DHS-3491).

· Programs that do not need to certify ASAM level of care: tribally licensed programs, ASAM 3.7 medically monitored inpatient programs, and adolescent residential programs

· In the Eligible Members section, we removed 1115 SUD System Reform Demonstration information. All MHCP members are eligible for SUD services delivered by MHCP enrolled 1115 SUD System Reform Demonstration Providers. Only members in major program MA qualify for the enhanced rate.

· Under the Covered Services heading, we:

· Clarified legal references and added certified ASAM level(s) of care.

· Removed 1115 Substance Use Disorder System Reform Demonstration information.

· Removed section about residential rates delivered for the applicable level of care will be enhanced by 25 percent over the basic per diem rates identified in the BHF Service Rate Gride with Dollar Amounts (DHS-7612).

· Removed section about outpatient rates for individual and group treatment paid at 20 percent over the base rate.

· Clarified language in the Substance Use Disorder treatment with Medications for Opioid Use Disorder (SUD-MOUD) services.

· Under the Noncovered Services heading, we:

· Removed services delivered before the completion of a comprehensive assessment.

· Removed treatment services delivered to people enrolled in a managed care plan, with exception of room and board services.

· Removed CCBHCs, federally qualified health clinics and rural health clinics are not eligible for 1115 rate enhancements.

· Under the Billing heading, we:

· Clarified the heading Outpatient Nonresidential programs.

· Removed 1115 SUD System Reform Demonstration residential treatment services billing information.

· Added clarification within the Revenue and Procedure Codes table to Service limitation for Peer Recovery Support H0038 U8.

· Removed Revenue for ASAM level of care for residential treatment services.

· Under the Billable Units and Time Requirement section, we:

· Clarified residential programs skilled treatment hours.

· Added How to determine missed services in a residential level of care information.

· Added Holiday Scheduling Flexibility information.

· Under the Managed Care Organization (MCO) Enrollees section, we updated policy to show that Room and Board Services are now covered for all MCO members.

· Under the Billing for Member Services in Institution for Mental Disease facilities heading, we removed instructions for IMDs enrolled in the 1115 Demonstration.

· Under the Utilization Management heading, we clarified information that providers are subject to participation in utilization reviews.

January 6, 2025

Mental Health Services

· Partial Hospitalization Program – Under the Billing heading, we added type of bill (TOB) 85X for billing as a Critical Access Hospital.

Reproductive Health/OB-GYN

· Reproductive Health/OB-GYN – We added a hyperlink to the new Home Birth page. The Minnesota Department of Human Services will cover home birth services effective Jan. 1, 2025, as part of its Minnesota Health Care Programs.

January 2, 2025

Anesthesia Services

· Anesthesia Services – Under the Billing heading, we added the 2025 Anesthesia Rates table and removed the 2023 table.

Equipment and Supplies

· Orthotics and Prosthetics – Under the Covered Services, Implantation of Iris Prosthesis heading, we clarified the codes for the implantation procedure and for the iris prosthesis.

Individualized Education Program (IEP) Services

· Special Transportation Services

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

· We updated language for clarity.

Optical Services

· Optical Services – Under the Covered Services heading, we updated to state iris prosthetics are covered effective Jan. 1, 2025, for members with aniridia. Prior authorization is always required.

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 – Under MTM-MNET, SmartLink and Local County or Tribal Agency-Administered Transportation Personal Mileage Codes, Modifiers and Payment Rates, we updated the quarterly IRS mileage rates for Jan. 1, 2025.

· State-Administered Transportation Procedure Codes, Modifiers and Payment Rates – Under Transportation Procedure Codes, Modifiers and Payment Rates, we updated quarterly fuel adjustments for Jan. 1, 2025.

January 1, 2025

Moving Home Minnesota

· We updated the MHM Demonstration and Supplemental Services Table with rate changes and policy updates. We also clarified some of the text. All rate changes are effective January 1, 2025. For questions regarding the changes, email the MHM team at MovingHomeMN.MFP@state.mn.us.

Enroll with MHCP

· Recuperative Care Enrollment Criteria and Forms

· We updated the note on the top of the page to reflect that we are resuming provider enrollment for recuperative care services on Jan. 1, 2025.

· Under How to Enroll, Online MPSE Portal and Complete and Submit Forms by Fax, we added a hyperlink to Recuperative Care – Health Services Provider Acknowledgment (DHS-8562).

Recuperative Care

· Recuperative Care

· We removed the note on the top of the page because we are resuming provider enrollment for recuperative care services on Jan. 1, 2025.

· Under Authorization, Recuperative Care Extended Stay, we updated language to reflect an authorized extension is needed if services are required for more than 21 days instead of 60 days. We also added that extended stays are not expected to go past 60 days.

· Under Authorization, Readmissions, we updated language to reflect a 21-day limit instead of the previous 60-day limit.

· Under Billing, Recuperative Care Health Services Claim (Professional Claim), we added a hyperlink for Recuperative Care – Health Services Provider Acknowledgment (DHS-8562).

· We updated language for clarity.

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Previous Revisions

2024 Manual 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