MHCP Provider Manual

Latest Manual Revisions

Revised: October 9, 2018

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.

October 9
Community Paramedic Services
  • Community Paramedic Services
  • Removed Emergency Medical Technician (EMT) under eligible provider section to clarify this manual section is specifically for community paramedics.
  • Changed wording under eligible recipients to clarify the member only has to have one of the issues listed to receive services.
  • Changed recipient to member throughout the page.
October 8
Equipment and Supplies
  • Spirometers – MHCP used to cover spirometers for home monitoring of pulmonary function following lung or heart transplants, but now covers spirometers for home monitoring of respiratory or cardiovascular conditions. We updated text in several places in this section to reflect this.
October 5
Hospital Services
  • Hospital Services
  • Under Institution for Mental Disease (IMD) we added: Adults under age 65 and children under age 21 who are admitted to an IMD are not eligible for Medical Assistance (MA).
  • Added a new section for Psychiatric Residential Treatment Facility (PRTF): A PRTF provides active treatment to children and youth under age 21 with complex mental health conditions. This is an inpatient level of care provided in a residential facility rather than a hospital. PRTFs deliver services under the direction of a physician, seven days per week, to residents and their families, which may include individual, family and group therapy. Children and youth under the age of 21 are eligible based on medical necessity. PRTFs are not subject to the IMD exclusion; they qualify as accredited, licensed inpatient psychiatric hospitals.
Home Care Services
  • Home Care Services – Updated with the face-to-face visit requirement in the covered services section. Also added under Noncovered services information about the services not being covered without the required documentation.
  • Home Care Nursing (HCN) Services – Class A licenses are no longer issued by the Minnesota Department of Health, as of 2014 the license required for providers is the Comprehensive Homecare License.
  • Home Health Aide Services –We updated this section to comply with the requirement for Home Health Agencies to have a Comprehensive Home Care license for enrollment with MHCP.
  • Skilled Nurse Visit (SNV) Services – Updating the manual page to reflect the correct type of licensure that is required for enrolling as a Home Health Agency.
Provider Basics
  • Billing the Recipient – Revised criteria for billing a member for prescriptions.
Hearing Aid Services
  • Hearing Aid Services Codes – Updated Hearing Aid Services Codes List to reflect added coverage for HCPCS V5020 - Conformity Evaluation, and also added instructions for requesting authorization of FM Systems V5281 and V5282.
  • Cochlear Implants – Reactivated HCPCS code L8625 effective Jan 1, 2018. Updated descriptions for HCPCS codes L8618, L8624, and L8691
October 4
Hospital Services
  • Inpatient Hospital Authorization – Added Psychiatric Residential Treatment Facility (PRTF) in Admissions Requiring Inpatient Hospital Authorization (IHA).Added definition of Psychiatric Residential Treatment Facility (PRTF).
October 3
Optical Services
  • Optical Services – Authorization requirement removed for vision therapy or orthoptics and pleoptics.
  • Removed language stating:
  • 1) 92071 and 82072 include the supply of contact lens
  • 2) Claims for contact lenses for the same date of service will be denied.
  • Removed the two year stipulation regarding replacement eyeglasses. Replacement eyeglasses can be given when one of the listed medical necessities are met.
October 2
Provider Basics
  • Enrollment with Minnesota Health Care Programs (MHCP) – Added transportation to provider list. Changed Optometrist to Optical and added all optical providers in this category.

September 14
Pharmacy Services
  • Pharmacy Early-Refill Overrides – We combined the controlled and noncontrolled override charts into this one section.
September 10
Dental Services
  • Children and Pregnant Women
  • Under Oral evaluations took out that prophylaxis can't be done on same day as comprehensive evaluation. This is not a policy change; this information was added inadvertently in the incorrect place.
  • Under Orthodontics for children through age 20, added that MHCP covers orthodontic treatment that meets the specifications of utilization criteria for children through age 20.
September 7
Pharmacy Services
  • Pharmacy Services – The criteria for refill-too-soon has changed. Added new situations to refill.
Equipment and Supplies
  • Mobility Devices – Under Eligible Providers, we removed the requirement of billing K0462 with modifier RR.
September 6
Provider Basics
  • Emergency Medical Assistance (EMA) – Added psychiatric residential treatment facility (PRTF) as an approved behavioral health emergency medical condition.Added a section under Requesting Renewal of a Care Plan Certification with provider requirements.Under Noncovered Services, added Early and Periodic Screening, Diagnosis and Treatment (EPSDT) services in conjunction with care in a PRTF.
Provider Basics
Enroll with MHCP
  • Home and Community Based Services (HCBS) Programs Provider Enrollment – Revised step 7, H, to include SLS to exception for requirement of general liability insurance.
HCBS Waiver Services
  • HCBS Waiver Services – Updated the Covered and Noncovered Services chart by adding bullets for the three different type of Employment Services and linked to the CBSM pages. Also added link to direct Individualized Home Supports, Remote Support - Individualized Home Supports, and Remote Support - Supported Living Services for Adults in Own Home to their CBSM pages. Added an "X" for Personal Support to reflect the service is covered under BI, CAC, and CADI effective July 1, 2018. Added "X" for Adult Companion to reflect the service is covered under CAC waiver effective October 1, 2018.
September 5
Dental Services
  • Non-Pregnant Adults – Under Covered Services, we made a correction that D0120 and D0150 can be done on the same day as a prophylaxis and D0140 cannot be done on the same day as a prophylaxis. Added D9239 to covered services.
Anesthesia Services
  • Anesthesia Services – A CMS price change of $0.03 increased 2018 rates for modifiers QY, QK, QK GC, and QX. DHS reprocessed claims from Jan. 1, 2018, through July 20, 2018. The adjustments appeared on the August 21, 2018, remittance advice.
Early Intensive Developmental and Behavioral Intervention (EIDBI) Benefit
  • Early Intensive Developmental and Behavioral Intervention (EIDBI) Benefit– DHS will now accept enrollment applications and claims for CMDE clinical trainees. Added language for providers to check the recipient's eligibility monthly prior to submitting for authorization. Added link to Authorization section under Provider Basics in the MHCP Provider Manual under Eligible Providers. Added update to billing for telemedicine services. Added links to new brochures under Additional Resources.

August 24
Mental Health Services
  • Adult Mental Health Targeted Case Management (AMH-TCM) and Children’s Mental Health Targeted Case Management (CMH-TCM) – The MHCP Provider Manual pages for adult and children's mental health targeted case management (AMH-TCM and CMH-TCM) have merged to form one resource for mental health targeted case management information.
August 20
Individualized Education Program (IEP) Services
  • Personal Care Assistance (PCA) Services – Moved information about the PCA knowledge of emergency procedures and documentation from plan of care to Required Training. Removed old plan of care text and revised to clarify what information is required in a PCA Plan of Care. Added information about the plan of care that may be in the IEP or IFSP or a separate document. Also included an example of the level of documentation needed for a PCA Plan of Care.
August 14
Community Health Worker (CHW)
  • Community Health Worker (CHW) – Updated Billing section to include groups larger than 8.

July 27
Mental Health Services
  • We added a new section for Psychiatric Residential Treatment Facilities (PRTF). PRTFs are a new, high intensity residential treatment benefit for recipients under 21 years old in need of, and appropriate for receiving mental health service from a PRTF.
Hospital Services
  • Outpatient Hospital Services – Physician's order for observation must be part of the recipient's records.Deleted outdated information about the Pay-for-Performance program.
July 26
Early Intensive Developmental and Behavioral Intervention (EIDBI) Benefit
  • Early Intensive Developmental and Behavioral Intervention (EIDBI) Benefit grid – We added billing instructions for CMDE clinical trainee. Also added procedure code time instructions for billing 15 and 30 minute units.
July 25
Provider Basics
Billing Policy (Overview)
  • Medicare and Other Insurance – Added explanation of calculation for claims for members who are dually eligible in the Medicare B Crossover Claim Payment section. Added directions for billing different procedure codes to MHCP than codes billed to the primary insurer.
July 23
Provider Basics
Programs and Services
  • MHCP Benefits at-a-glance– Updated wording referencing transportation services for both non-ambulance and ambulance transports. Non-ambulance transports adjustment include removal of the references to "access/common carrier" and "STS" transport types which are no longer proper descriptions of the service coordinated by the local county/tribal local agencies or MHCP enrolled providers.
July 9
  • Clinic Services – We made the following update to the MHCP Provider Manual Clinic Services section: on the "Billing for PHNC Services" table, we changed the billing unit for Nursing Care code S9123 from one hour to one visit and added guidance to use the U8 modifier when billing evidence-based home visits.
Mental Health Services
  • Intensive Treatment in Foster Care – We updated the Billing section to advice providers to bill in MN–ITS using 837P claims.
July 2
Moving Home Minnesota
  • Moving Home Minnesota Demonstration and Supplemental Services Table – Updated the row for Supported Employment Services with end date of 8/31/18, for the 15 minutes procedure code.

June 29
  • Provider Requirements – Moved content specifically for enrolling as an MHCP provider out of this manual section to a new sections for each provider type. Refer to Enrollment with Minnesota Health Care Programs.
  • Moved content about excluded providers and checking the federal and state exclusions lists to a new section: Excluded Provider Lists.
  • Added a section about the requirements for Nondiscrimination. All MHCP enrolled providers must post a notice of nondiscrimination practices. This explains where to post the notice and what it must include.
  • Revised language under Health Service Records for Specific Providers under Medical equipment and suppliesabout maintaining records to clarify that physician's order or prescription may be photocopy or fax image, electronic, or original "pen and ink" documents.
June 22
  • Mental Health Services – We added a paragraph about the requirement of mental health services outcome reporting in the Mental Health Information System (MHIS) and the Children's Mental Health Outcome Reporting System.
June 19
Equipment and Supplies
  • Mobility Devices – Under Eligible Providers, TPL and Medicare, we added that Medicare does not cover wheelchair transit systems or tie downs, transport brackets, or similar wheelchair accessories. Providers may bill MHCP directly for these accessories that are part of a covered wheelchair. Follow MHCP authorization requirements. When billing, include an attachment that clearly states "wheelchair transportation accessory not covered by Medicare." MHCP does not cover accessories that are modifications to a vehicle.
June 13
Equipment and Supplies
  • Patient Lifts and Seat Lift Mechanisms– We added that rental or purchase of electric patient lifts (E0635) now require prior authorization.
June 6
Provider Basics
Programs and Services
Emergency Medical Assistance (EMA)
  • Kidney Transplant Services– We clarified that the transplant facility must be Medicare-certified.
June 1
Equipment and Supplies
  • Nutritional Products and Related Supplies– We updated language to comply with a 2016 legislative change that allows pricing by report for enteral nutritional products. Also, clarified what documentation is required for authorization of food thickeners.

May 31
Individualized Education Program (IEP) Services
  • IEP Billing and Authorization Requirements– Clarified requirements to bill evaluations when providing the face-to-face assessment for an evaluation. Use place of service 02, and modifier GT in addition to the assigned U1 - U5 modifiers.
PCA Services
  • Personal Care Assistance (PCA) Services– We removed language to clarify that PCA agencies do not require licensure through the Minnesota Department of Health.
May 30
Early Intensive Developmental and Behavioral Intervention (EIDBI)
  • Early Intensive Developmental and Behavioral Intervention (EIDBI) Provider Enrollment – Providers enrolling at QSP, Level I and Level II will need to obtain an NPI number from the NPPES website. Also, added process for CMDE clinical trainees to enroll.
HCBS Waiver Services
  • HCBS Waiver Services – We added employment services, individualized home supports, and remote support onto the Covered/Noncovered Services chart.
Mental Health
  • Mental Health Medication Management– We are deleting this section because the information can be found in other sections of the MHCP Provider Manual. Specifically, you can find the information in the following sections: Mental Health Services; Evaluation and Management Services; and Physician Consultation, Evaluation and Management.
May 23
Equipment and Supplies
  • Orthopedic and Therapeutic Footwear – We updated this section with the following:
  • MHCP now covers three pairs of therapeutic inserts including codes A5512, A5513, K0903 in a calendar year without authorization. Two pairs of inserts under code A5510 are still covered without authorization. Authorization for therapeutic footwear is required only when a third pair or subsequent pair of therapeutic shoes, a third pair or subsequent pair of inserts under code A5510, or a fourth pair or subsequent pair of inserts (A5512, A5513, K0903) is required in any calendar year.
  • MHCP covers two pairs of orthopedic shoes and two pairs of inserts in a calendar year without authorization. Authorization for orthopedic footwear is required only when a third pair or subsequent pair of orthopedic shoes or a third pair or subsequent pair of inserts is required in any calendar year.
Provider Basics
  • Authorization – Authorization requests for EIDBI will follow the same rules for home care authorization requests, that is, EIDBI providers will no longer need to send primary insurance information to KEPRO to receive an authorization.Added individual treatment plan (ITP) progress monitoring under EIDBIas a service requiring KEPRO authorization.
May 22
Elderly Waiver (EW) and Alternative Care (AC)
  • Elderly Waiver (EW) and Alternative Care (AC) Program – We added links to the Community-Based Services Manual (CBSM) for the following services in the Covered Services section: Customized Living, Nutrition Services and Personal Emergency Response Systems (PERS).
Provider Basics
Provider Requirements
  • Access Services – Updated the Spoken Language Interpreters subsection to clarify this is referring to face-to-face spoken language interpreters who must be on the MDH Spoken Language Interpreter Roster.
Transportation Services
  • Local County or Tribal Agency Nonemergency Medical Transportation (NEMT) Services – In the Documentation section, added that documentation must include the provider's NPI or UMPI number. Deleted that information must be recorded on a trip sheet.
May 18
Housing Support Supplemental Services
  • Housing Support Supplemental Services – We clarified that a copy of the signed Housing Support Agreement with the lead agency is a required form for enrollment with MHCP.
May 16
Mental Health Services
  • Intensive Residential Treatment Services (IRTS) – We added information to the Billing section advising providers not to bill for the date of discharge.
Provider Basics
Programs and Services
  • Health Care Programs and Services Overview – Added information about how spenddowns work when a member eligible for Medical Assistance is enrolled in a managed care plan.
May 15
Essential Community Supports (ECS)
  • Essential Community Supports (ECS) – Updated the link for Community Living Assistance (CLA) in the Overview and Covered Services sections to direct users to that information in the Community-Based Services Manual (CBSM).
  • The policy content for Community Living Assistance (CLA) has moved to the Community-Based Services Manual (CBSM). Refer to the CBSM for CLA information.
May 11
Early Intensive Developmental and Behavioral Intervention (EIDBI) Benefit
  • Early Intensive Developmental and Behavioral Intervention (EIDBI) Benefit– We made changes to clarify a person's eligibility for the EIDBI benefit, and to direct new providers to contact KEPRO to alert them of their NPI. Also made an update because EIDBI providers no longer need to submit other insurance information to KEPRO when asking for a service authorization.
May 10
Housing Support Supplemental Services
  • Housing Support Supplemental Services – Updated this manual section title from Group-Residential-Housing-(GRH)-Supplemental-Services to Housing Support Supplemental Services. The text was clarified through-out manual. New section was added for approved supplemental service diagnosis codes to be used on all claims submission.
May 9
Individualized Education Program (IEP) Services
  • Record Keeping and Documentation– We added information to clarify co-treatment of OT, PT and SLP services. Also clarified co-treatment for PCA service or nursing service when it is necessary to have two providers assist with the same service.
Physician and Professional Services
  • Physician and Professional Services:
  • Deleted reference to Pay-for-Performance program; this program has ended
  • Billing Telemedicine Services: Deleted GT as a modifier when billing for telemedicine services; GT is no longer required as of April 1, 2018. Clarified that place of service 02 certifies that you are providing services to a patient via audio and visual telecommunications.
  • Updated the definition of Advanced Practice Registered Nurse (APRN) according to Minnesota Statutes.
  • Under Physician Assistants, deleted nurse practitioners as noncovered – nurse practitioners are allowed as assistants at surgery.
  • Added correctional facility-based office as an originating site for Telemedicine
May 8