MHCP Provider Manual

Latest Manual Revisions

Revised: 04-20-2017

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.

04-20-2017
Addition(s)/Revisions
Reproductive Health/OB-GYN
  • Minnesota Family Planning Program (MFPP) Procedure Codes– Codes 87806 for Alere HIV testing and 11983 for contraception were added to the MFPP Procedure Codes list.

04-17-2017
Addition(s)/Revisions
Provider Basics
Programs and Services
  • Program HH (HIV/AIDS) Covered Services – Program HH now covers fixed partials (crowns and pontics).

Provider Basics
Provider Requirements
  • Access Services
  • Clarified under Covered expenses the local agency requirements to inform members about transportation and ancillary services.
  • Clarified interpreter information that transportation providers reimbursement does not include interpreter service reimbursements, and to submit an authorization request for additional interpreter service units only after the allowed 8 units have been used.

Transportation Services
  • Local County or Tribal Agency Nonemergency Medical Transportation (NEMT) Services – Information added to better identify transport mileage reimbursements for personal mileage and volunteer drivers.Beginning April 1, 2017, MNET will coordinate Local County or Tribal Agency Nonemergency Medical Transportation (NEMT) Services for Mille Lacs County.

04-14-2017
Addition(s)/Revisions
Equipment and Supplies– Weighted Vests have been added to the Weighted Blankets section.
  • Positioning Equipment – Positioning systems have been added to the third bullet point under Positioning Cushions, Pillows and Wedges section of the policy.

04-07-2017
Addition(s)/Revisions
Elderly Waiver (EW) and Alternative Care (AC) Program – Added Individual Community Living Support (ICLS) servicesand added a link to the Community Based Services Manual (CBSM) under Covered Services.
03-28-2017
Addition(s)/Revisions
Anesthesia Services – Removed 2015 anesthesia rate information and added the 2017 anesthesia rates.
Intermediate Care Facilities (ICF/DDs) – Changed link for MN–ITS user manual from HCBS Waiver, Alternative Care (AC), Moving Home Minnesota and Group Residential (GRH) Supplemental Services claims to DT&H and ICF-DD Special Needs claims under Billing.
03-23-2017
Addition(s)/Revisions
Alcohol and Drug Abuse Services – Updated DAANES communication to advise providers of new MHCP DAANES contact. Removed outdated MinnesotaCare information from Managed Care section. Updated rate reform grid effective date from 3/1/2013 to 9/9/2016. Updated Revenue and Procedure Code table to include High Intensity Committed/Complex codes.
03-17-2017
Addition(s)/Revisions
Provider Basics
  • Managed Care Organizations (MCOs) and Prepaid Health Plans (PPHPs) – Added RSC-TCM carved out service for SNBC enrollees and made text clarifications throughout the section.

03-16-2017
Addition(s)/Revisions
Child and Teen Checkups (C&TC) –Clarified information for nonenrolled public health nurses in the Eligible Providers section.
Laboratory/Pathology, Radiology & Diagnostic Services
  • Laboratory and Pathology Services – Clarified genetic testing for breast cancer. MHCP allows payment for one of the following tests:
  • Oncotype Dx – bill this test using HCPC S3854 or
  • EndoPredict – bill this test using HCPC S3854 beginning Jan. 1, 2017.

03-15-2017
Addition(s)/Revisions
Individualized Education Program (IEP) Services
  • Interpreter Services – Clarified under Overview when Medical Assistance will reimburse for interpreter services and under Sign Language Interpreter Services that inclusion on the Minnesota Department of Health roster is not evidence that the person is certified as an interpreter.

03-13-2017
Addition(s)/Revisions
Early Intensive Developmental and Behavioral Intervention (EIDBI) Benefit – Updated EIDBI policy manual links and edited Service Agreement and Billing content. Added links to 60 day temporary increase form and Technical Change form.
03-10-2017
Addition(s)/Revisions
Child and Teen Checkups (C&TC) – In the Maternal Depression Screening subsection we added language regarding a NCCI bundling edit when using code 96161. In the Vision Screening subsection we revised language regarding an NCCI bundling edit when using code 99173.
03-08-2017
Addition(s)/Revisions
Dental Services (Overview) – Added a section "Locum Tenens Dentist" with information about allowing a dentist to retain a substitute dentist for reasons such as illness, vacation, education and medical leave.
Equipment and Supplies – Updated miscellaneous product section to include information for weighted blankets.
03-07-2017
Addition(s)/Revisions
Equipment and Supplies
  • Nutritional Products and Related Supplies – Minor revisions due to 2017 HCPCS changes. Changed code for feeding pumps from B9000 to B9002. Added information for repairs to pumps originally dispensed at B9000 in the Billing subsection.

03-03-2017
Addition(s)/Revisions
Mental Health Services
  • Adult Rehabilitative Mental Health Services (ARMHS) – Error on billing table. Changing H0031 UD TS from mental health assessment, by physician, follow-up service (review or update) to mental health assessment, by non-physician, follow-up service (review or update).
  • Dialectical Behavior Therapy Intensive Outpatient Program (DBT IOP) – The recommended duration for DBT –IOP skills group training has been changed to a minimum of two hours weekly with an option to last up to two and a half hours. Updated team member requirements and discharge criteria.

03-02-2017
Addition(s)/Revisions
Behavioral Health Home Services – The BHH services section of the MHCP Provider Manual has been updated with the following:
  • Clarify that there is not a particular order in which providers must assess eligibility for BHH services; simply that they must ensure that all criteria have been met
  • Clarify that provider type is required if BHH services provider is billing using a billing entity
  • Clarify that BHH providers must submit claims that correspond with the BHH services certification approval letter

Early Intensive Developmental and Behavioral Intervention (EIDBI)
  • Early Intensive Developmental and Behavioral Intervention (EIDBI) Benefit Grid – Updated provider limits and service limits on the EIDBI billing grid.

02-24-2017
Addition(s)/Revisions
Equipment and Supplies
  • Oxygen Equipment
  • Clarified billing policy for dually eligible recipients in long-term care facilities.
  • Added that MHCP does not cover the following:
  • Stands, racks, and wheeled carts for oxygen equipment
  • Replacement accessories for portable concentrators

Provider Basics
Billing Policy
  • Payment Methodology – Hospital – General clarifications throughout the section, including the following:
  • Revised and updated this section to reflect the Legislation that passed in 2013 directing DHS to develop new payment methodologies for fee-for-services (FFS) inpatient hospital services provided by diagnosis related group (DRG) hospitals, critical access hospitals, and rehabilitation hospitals
  • Deleted outdated information about programs or services that have ended
  • Updated the Critical Access Hospital subsection to reflect the new MHCP cost-based inpatient payment methodology according to the 2013 legislative directive
  • Deleted the outdated process of appeal for case mix procedure
  • Updated the Inpatient Hospital Services subsection to show the new payment methodologies for fee-for-services (FFS) inpatient hospital services provided by diagnosis related group (DRG) hospitals, as directed in the 2013 legislation
  • Updated and clarified some of the definitions

02-22-2017
Addition(s)/Revisions
Pharmacy Services
  • 340B Drug Pricing Program – Under 340B-covered entities, changed "children's hospitals" to "free-standing cancer hospitals." Deleted the Managed Care Organizations (MCOs) subsection and clarified information for 340B Contract Pharmacies.

02-21-2017
Addition(s)/Revisions
Child and Teen Checkups (C&TC) – In the Maternal Depression Screening subsection we added that a modifier is needed when using code 96161.
Eyeglass and Vision Care Services – Added contact information for new vendor, Classic Optical Laboratories, Inc. Clarified coverage criteria for specialty eyeglass lenses and changed quantity limits for contract to comply with federal Correct Coding Initiative (CCI) editing requirements.
02-15-2017
Addition(s)/Revisions
Equipment and Supplies
  • Diabetic Equipment & Supplies
  • Removed obsolete information about providers who may provide diabetic equipment and supplies.
  • Under Blood Glucose Monitors:
  • Code E0607 is no longer an eligible covered code
  • Deleted statement that authorization is required only for excess quantities. Authorization is always required for specialty blood glucose monitors E2100 and E2101.
  • Deleted Authorization information from the Blood Glucose Test Strips subsection

Mental Health Services
  • Adult Rehabilitative Mental Health Services (ARMHS) – Corrected 02/06/2017 changes to ARMHS billing table.

02-10-2017
Addition(s)/Revisions
Pharmacy Services
  • Point of Sale Diabetic Testing Supply Program – Updated Preferred Blood Glucose Monitors and Preferred Blood Glucose Testing Strips product and NDC tables.

Mental Health Services
  • Adult Rehabilitative Mental Health Services (ARMHS) – The billing table has been changed to add updates to ARMHS coding for transition to community living. Modifier UD has been updated to U3 and now reads as follows:
  • H2017 U3 - Basic living and social skills, transitioning to community living (TCL)
  • H2017 U3 HM - Basic skills, transitioning to community living (TCL) by a mental health rehabilitation worker

Provider Basics
Provider Requirements
  • Access Services– Added process for authorization of interpreter units after the allowed 8 units for a single date of service.

02-06-2017
Addition(s)/Revisions
Individualized Education Program (IEP) Services
  • IEP Providers – IEP provider contact list updated with new DHS email address for sending in new or updated contact information.

Mental Health Services
  • Adult Rehabilitative Mental Health Services (ARMHS) – The billing table has been changed to add updates to ARMHS coding for transition to community living. Modifier UD has been updated to U3 and now reads as follows:
  • H2017 U3 - Basic living and social skills, transitioning to community living (TCL)
  • H2017 U3 HM - Basic skills, transitioning to community living (TCL) by a mental health rehabilitation worker

Provider Basics
Provider Requirements
  • Access Services– Added process for authorization of interpreter units after the allowed 8 units for a single date of service.

02-03-2017
Addition(s)/Revisions
Reproductive Health/OB-GYN
  • Minnesota Family Planning Program (MFPP) Procedure Codes– Clarified which code to use when prescribing hormonal or nonhormonal contraceptives.

02-02-2017
Addition(s)/Revisions
Physician and Professional Services – added link to Gender-Confirming Surgery in the Table of Contents.
  • Gender-Confirming Surgery – Added a new section about MHCP coverage for gender confirming surgery.

01-27-2017
Addition(s)/Revisions
Hospital Services
  • Inpatient Hospital Services – Added Emergency Medical Assistance coverage of kidney transplants in the Coverage Limitations subsection.

01-23-2017
Addition(s)/Revisions
HCBS Waiver Services – Addednight supervision services under Covered Services for CADI.
01-20-2017
Addition(s)/Revisions
Equipment and Supplies
  • Mobility Devices – Minor revisions to reflect changes to HCPCS codes that include the following:
  • Added manual wheelchair accessory code K0077
  • Under Wheelchair Options and Accessories:
  • Added E1012 to power leg elevation systems
  • Added E1014 to manual, fully or semi-reclining backs.

Laboratory/Pathology, Radiology & Diagnostic Services
  • Laboratory and Pathology Services - Under Drug Testing we:
  • Changed HCPC codes G0477- G0479 to CPT codes 80305-80307 or G0480 – G0483 per encounter for dates of service on and after January 1, 2017.
  • Clarified that effective November 1, 2016, codes 80300-80304 and 80320 – 80377 are no longer covered
  • Added that effective January 1, 2017, codes G0477 – G0479 will be deleted

Mental Health Services
  • Psychotherapy – Clarified billing for codes 90846-90849 that are used to report family psychotherapy. Family psychotherapy coding may be separately reported for each patient in the family group, however, it should not be reported for each family member.

Reproductive Health/OB-GYN
  • Minnesota Family Planning Program (MFPP)– Added covered diagnosis code range to the Covered Services section.

01-19-2017
Addition(s)/Revisions
Programs and Services
  • Emergency Medical Assistance (EMA) - Added that EMA covers nonemergency medical transportation only for services covered under EMA under the Covered Services section.

01-17-2017
Addition(s)/Revisions
Laboratory/Pathology, Radiology & Diagnostic Services
  • Radiology/Diagnostic Services – Updates under Billing subsection for Medicare outpatient hospital changes effective 2016 and 2017 for computed tomography modifier CT, x-rays taken by film (requiring modifier FX) and stereotactic radiosurgery planning and delivery modifier CP.

01-13-2017
Addition(s)/Revisions
Physician and Professional Services
  • Removed mental health telemedicine information from this section and linked to the Telemedicine Delivery of Mental Health Services section for this information.
  • Added services to the Coverage Limitations section that are not covered under telemedicine.
  • Added off-campus provider-based billing changes for modifiers PO and PN.
  • Added a section for Off-Campus Provider-Based Hospital Department Services

Transportation Services
  • Access Services Ancillary to Transportation – Added Emergency Medical Assistance (EMA)and Minnesota Family Planning Program (MFPP) to the Eligible Recipients section.
  • Ambulance Transportation Services – Removed reference to ICD-9 codes.
  • Local County or Tribal Agency Nonemergency Medical Transportation (NEMT) Services – Added Emergency Medical Assistance (EMA) to the Eligible Recipient section. Added to the Noncovered Services section that transport is not covered for EMA recipients for obtaining routine or preventative care or services.
  • Nonemergency Medical Transportation (NEMT) Services (Overview) – Added Emergency Medical Assistance (EMA) to the Eligible Recipient section and added to the Noncovered Services section that transport of an EMA recipient for routine or preventative care is not covered.
  • Protected Transportation Services – Clarification of major program eligibility information for Eligible Recipients.
  • State-Administered NEMT – Added Minnesota Family Planning Program (MFPP) and Emergency Medical Assistance (EMA) to Eligible Recipients.

01-12-2017
Addition(s)/Revisions
Hospital Services
  • Inpatient Hospital Authorization – Added EMA kidney transplant to the list of Admissions Requiring Inpatient Hospital Authorization.

01-11-2017
Addition(s)/Revisions
Early Intensive Developmental and Behavioral Intervention (EIDBI)
  • Early Intensive Developmental and Behavioral Intervention (EIDBI) Provider Enrollment – Revised the Assurance Statement titles by removing the reference to DBI and ABA for providers Levels I,II,III.

Equipment and Supplies
  • Electrical Stimulation Devices – Minor changes to reflect 2017 HCPCS code description change under Covered Services.

Provider Basics
Billing Policy
  • Billing the Recipient – Added information for the 2017 copays and family deductible.

01-09-2017
Addition(s)/Revisions
Equipment and Supplies
  • Patient Lifts and Seat Lift Mechanisms – Coding update for 2017 HCPCS codes.

01-06-2017
Addition(s)/Revisions
Mental Health Services
  • Mental Health Certified Family Peer Specialist – The new Mental Health Family Peer Specialist page has been added.

01-05-2017
Addition(s)/Revisions
Immunizations & Vaccinations – Changed age restrictions for CPT code 90686 and 90688 from 3 years to 6 months and older.
Rehabilitation Services
  • Audiology Services Procedure Codes – Updated page title, removed "authorization required"for code 92700 and replaced with "description required".

01-04-2017
Addition(s)/Revisions
Mental Health Services
  • Adult Day Treatment – Added an Overview section defining what constitutes a day treatment service and the MN statutes that explain what facilities can provide the service.
  • Adult Rehabilitative Mental Health Services (ARMHS) – Updated adult rehabilitative mental health services (ARMHS) definition to reflect MN Statute 256B.0623, Subd. 2. Updated modifiers for HCPS codes H0031 and H0032 on billing grid. The following changes were applied to the billing table:
  • H0031 Brief Description changed from Functional Assessment to Mental Health assessment by non-physician and the UD modifier was added.
  • Modifier UD was added to the TS modifier for H0031 Functional Assessment Update/Review.
  • The UD modifier was added for procedure H0032 Individual Treatment Plan.
  • Modifier UD was added to the TS modifier for H0032 Individual Treatment Plan Update/Review.
  • Per 15 minutes was added to the unit section of the billing table for the services, Functional Assessment, Mental Health Assessment (H0031 UD/H0031 UD TS) and Functional Assessments (H0032 UD/H0032UD TS).

Provider Basics
Provider Requirements
  • Provider Screening Requirements – Updated text from old fee amount to new fee amount.
  • Risk Levels and Enrollment Verification Requirements – Changed provider type 72 from broker to coordinator to more closely fit the definition of enrolled provider type 72.

Rehabilitative Services
  • Rehabilitative Services Procedure Codes – Added new 2017 OT/PT evaluation codes and updated some code descriptions.

Previous Revisions

2016 Manual Revisions

2015 Manual Revisions

2014 Manual Revisions

2013 Manual Revisions

2012 Manual Revisions

2011 Manual Revisions