Skip To: Main content|Subnavigation|
Minnesota Department of Human Services Provider Manual
DHS Home CountyLink Home Manuals Home Bulletins
Advanced Search
Show/Hide Table of Contents  

MHCP Provider Manual

Latest Manual Revisions

Revised: February 13, 2019

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.

February 13, 2019

Equipment and Supplies

  • Positive Airway Pressure for Treatment of Obstructive Sleep Apnea – Under Covered Services in the first and second paragraphs, we replaced "made consistent progress" with "demonstrated use of" and defined compliance during the additional eight-week period.
  • Early Intensive Developmental and Behavioral Intervention (EIDBI)

  • Early Intensive Developmental and Behavioral Intervention (EIDBI) billing grid – We removed the Level III providers row for Intervention - Individual: Observation and Direction: Adaptive behavior treatment with protocol modification.
  • Rehabilitation Services

  • • Revised "Therapy Students Providing Care" section to clarify when services provided by therapy students can be billed
  • • Added a section called "Eligible Ordering and Referring Providers"
  • • Corrected Physical Therapy provider titles
  • • Added a statement indicating Speech Language Pathologist Assistants are not eligible for Minnesota Health Care Programs enrollment or payment
  • • Clarified definition of "Practitioner of the Healing Arts" to remove oral surgeon and optometrist and add physician, clinical nurse specialist and certified nurse midwife
  • February 8, 2019

    Provider Basics
    Enroll with MHCP

  • Occupational Therapist Enrollment Criteria and Forms – Added new section for providers enrolling as occupational therapists.
  • February 5

    Early Intensive Developmental and Behavioral Intervention (EIDBI)

  • • We added service hour limits to the Person or Service Limits column of CMDE: Behavior identification assessment for the following providers:
  • • CMDE provider
  • • CMDE Clinical Trainee
  • • We added multiple provider billing information to the Person or Service Limits column of the ITP Development and Monitoring for the following providers:
  • • QSP
  • • Level I
  • • Level II
  • • We added that the Coordinated Care Conference cannot be billed with other EIDBI services, except the ITP to the Person or Service Limits column of the Coordinated Care Conference: Medical Team Conference for the following providers
  • • CMDE provider
  • • QSP
  • • Level I
  • • Level II
  • • We removed the Level III provider Family/Caregiver Training and Counseling - Group: Multiple family group adaptive behavior treatment guidance row.
  • February 1

    Mental Health Services

  • Dialectical Behavior Therapy Intensive Outpatient Program (DBT IOP) – We clarified exclusionary services under the Authorization section. Concurrent therapy is only allowed for family therapy, which includes justification and communication submitted with authorization materials. DBT is not allowed to be provided concurrently with outpatient psychotherapy or group psychotherapy, partial hospitalization or day treatment. This clarification assures the DBT therapist is leading the treatment of the individual and is adhering to the fidelity of the DBT model.
  • Laboratory/Pathology, Radiology & Diagnostic Services

  • • We added details for payment changes for computed radiography technology with modifier FY in the Billing section.
  • • We deleted Stereotactic Radiosurgery Planning and Delivery because this service ended.
  • Hearing Aid Services

  • • We added code V5030 and description Monaural, body worn, air conduction to the Hearing Aid Services Codes table
  • • We added code V5040 and description Monaural, body worn, bone conduction to the Hearing Aid Services Codes table
  • • We updated the description in the Hearing Aid Services Codes table for code V5070 to Hearing aid in glasses, air conduction
  • • We updated the description in the Hearing Aid Services Codes table for code V5080 to Hearing aid in glasses, bone conduction
  • • We updated the description in the Hearing Aid Services Codes table for code V5190 to Hearing aid, contralateral routing, monaural, glasses
  • • We updated the description in the Hearing Aid Services Codes table for code V5230 to Hearing aid, contralateral routing system, binaural, glasses
  • • We updated the notes in the Hearing Aid Services Codes table for codes V5170 CROS, ITE; V5180 CROS, BTE; V5210 BiCROS, ITE; V5220 BiCROS, BTE to V5170, V5180, V5210 and V5220 will end December 31, 2019. When billing repairs with a HCPCS code, use the same code that was billed when the aid was purchased.
  • • We added code V5171, description Contralateral routing device, monaural, in the ear (ITE) and notes in the Hearing Aid Services Codes table
  • • We added code V5172, description Contralateral routing device, monaural, in the canal (ITC)* and notes in the Hearing Aid Services Codes table
  • • We added code V5181, description Contralateral routing device, monaural, behind the ear (BTE) and notes in the Hearing Aid Services Codes table
  • • We added code V5211, description Contralateral routing system, binaural, ITE/ITE and notes in the Hearing Aid Services Codes table
  • • We added code V5212, description Contralateral routing system, binaural, ITE/ITC* and notes in the Hearing Aid Services Codes table
  • • We added code V5213, description Contralateral routing system, binaural, ITE/BTE and notes in the Hearing Aid Services Codes table
  • • We added code V5214, description Contralateral routing system, binaural, ITC/ITC* and notes in the Hearing Aid Services Codes table
  • • We added code V5215, description Contralateral routing system, binaural, ITC/BTE* and notes in the Hearing Aid Services Codes table
  • • We added code V5221, description Contralateral routing system, binaural, BTE/BTE and notes in the Hearing Aid Services Codes table
  • • We updated the description in the Hearing Aid Services Codes table for code V5200 to Dispensing fee, contralateral, monaural
  • • We updated the description in the Hearing Aid Services Codes table for code V5240 to Dispensing fee, contralateral routing system, binaural
  • • We updated the description in the Hearing Aid Services Codes table for code V5267 to Hearing aid supplies and accessories, not otherwise specified (use for rechargeable batteries, telecoils, tubes, ear hooks, receivers and other accessories); and we updated notes to Attachment with description required; include manufacturer's invoice or retail cost (MSRP) of the supply or accessory. Do not include service or labor charges when using this code.
  • • We updated notes in the Hearing Aid Services Codes table for code V5299 Miscellaneous hearing aid servicing to Attachment with description required to identify the service (labor only). Use for: ear wax removal and cleaning not associated with a hearing aid check; Hearing aid maintenance: ear hook, receiver and tube changes, etc. Use for other services that do not have a more specific HCPCS code.
  • • We corrected notes in the Hearing Aid Services Codes table for V5011 Hearing aid checks or reprogramming performed by a hearing aid dispenser. Cannot be billed with 92592 and 92593. Refer to the Audiology Service Thresholds when service is performed by an audiologist to Claims with DOS 90 days after the dispensing date will deny.
  • January 29

    Transportation Services

  • • We removed ATS transport from the second bullet point under Claim Information
  • • We removed the ICD-9 code under Claim Information
  • • We removed Modifier as a required entry for claim submission under Claim Information
  • Certified Community Behavioral Health Clinic (CCBHC) Federal Demonstration Project

  • • We have updated the H0032 code in the Integrated Treatment Plan table under the Billing section to no longer include the UD modifier.
  • • We have updated the H0031 code in the Functional Assessment table under the Billing section to no longer include the UD modifier.
  • Provider Basics

  • Billing the Recipient – Added text in Noncovered Services to further define services not covered:
  • • It is never covered by MHCP; or
  • • It is being provided by a provider that is out of network and a single case agreement has not been established
  • Also added text for a member to pay for a noncovered prescription if an Advance Member Notice has been completed.
  • January 25

    Anesthesia Services

  • Anesthesia Services – We added the 2019 rate table.
  • Provider Basics

  • Billing the Recipient – We updated the copay and deductible information for 2019.
  • Substance Use Disorder Services (SUD)
  • • We corrected the outpatient individual (nonresidential) treatment Service Limitations column to three units per day in the Revenue and Procedure Codes table under the Billing section.
  • • We corrected the outpatient group (nonresidential) treatment Service Limitations column to 10 units per day in the Revenue and Procedure Codes table under the Billing section.
  • January 24

    Early Intensive Development and Behavioral Intervention (EIDBI) Benefit

  • • We clarified qualifying health programs in the fourth bullet point in the Eligible People section.
  • • We removed 60-day temporary increase language in Services that Require Authorization under the Service Authorization section
  • • We updated language in Services that Do Not Require Authorization under the Service Authorization section
  • • We added a link to the 2018 billing grid in the Billing section.
  • • We deleted "Only bill codes for 'the first 30 minutes' one time per day, per clinician level modifier" under Submitting Claims in the Billing section.
  • • We added a link to updated state plan amendment in the Legal References section.
  • January 15

    Child and Teen Checkups (C&TC)

  • • We added to the Covered Services - Medical screenings subsection that fluoride varnish application is limited to four per 365 days.
  • • Under Immunizations and Vaccinations, Oral health, we added "or no later than 12 months of age" to the fluoride varnish application statement and under FVA primary provider billing that FVA is limited to four per 365 days.
  • • Under Covered Services - Dental Screening, we made the following changes:
  • • We changed clinical oral examination to "Clinical open mouth assessment"
  • • We deleted information about assessments or screening to clarify the medical provider role and expectations for dental screening as part of the full comprehensive C&TC exam.
  • Equipment and Supplies

  • Equipment and SuppliesWe added the requirement of following Minnesota Rules for electronically maintained records under Dispensing Orders and Detailed Written Orders.
  • Certified Community Behavioral Health Clinic (CCBHC) Federal Demonstration Project

  • • We added a section detailing comprehensive evaluation updates and assessment components.
  • • We added a section explaining Outpatient (ambulatory) Withdrawal Management - level 2 (2-WM) eligibility and covered services.
  • • We revised the billing section to include comprehensive evaluation updates and Outpatient Withdrawal Management services. The procedure codes H0031 & H0032 have changed to per session codes with a max of one session per day.
  • January 14

    Transportation Services

  • Local County or Tribal Agency Nonemergency Medical Transportation (NEMT) Services Claim, Service, and Rate Information – Updated mileage rates for Volunteer Driver (A0080) and Licensed Foster Parent (A0090 UC) to the 2019 IRS Standard Rate of $0,58 per loaded mile by the most direct route.
  • Substance Use Disorder Services (SUD)

  • • Revision to this Rule 25 manual section helps to delineate between the two ways individuals may access services through June 30, 2020. The Rule 25 process will end on July 1, 2020. We did not make any major changes, but moved billing information to the main substance use disorder (SUD) manual section.
  • • We are not changing the language for Rule 25 to substance use disorder (SUD); we will continue to follow the terminology as it is in the statutes governing Rule 25. That is, we refer to "CD" rather than SUD in this section. See statues: https://www.revisor.mn.gov/statutes/2016/cite/254A.19
  • January 11

    Transportation Services

  • Local County or Tribal Agency Nonemergency Medical Transportation (NEMT) Services – Beginning Jan. 1, 2019, Medical Transportation Management's Minnesota Nonemergency Transportation (MTM-MNET) will coordinate nonemergency medical transportation (NEMT) and ancillary services for Aitkin, Carlton, Lake, and St. Louis counties, in addition to the 13 counties they already coordinate for.
  • January 9

    Mental Health Services

  • Intensive Treatment in Foster Care – We corrected the number of units of service from 78 to 72 under Authorization for ITFC services. Authorization is required after 72 units of service.
  • January 4

    Substance Use Disorder Services (SUD)

  • • We revised this Substance Use Disorder (SUD) (formerly Alcohol and Drug Abuse) provider manual section to meet statutory requirements to comply with SUD reform that was passed by the Minnesota legislature during the 2017 session. According to the legislative changes, we updated this section with new billing codes, service types, billing policy and other information regarding new services.
  • January 3

    Provider Basics
    Enroll with MHCP

  • Billing Entity for Mental Health Enrollment Criteria and Forms – Under Enrollment Criteria we clarified that to enroll as a billing entity for mental health with Minnesota Health Care Programs (MHCP), the entity must have at least one of the listed providers in the group. This previously stated to have two. We added:
  • • Licensed professional clinical counselor (LPCC)
  • • Psychiatric nurse practitioner (NP)
  • • Psychiatry or osteopathic physician
  • • Mental health rehabilitative professional
  • • Tribal certified professionals
  • January 2

    Provider Basics

  • Provider Screening Requirements – We updated the provider manual to reflect the new provider screening and enrollment fee amount of $586.00, effective January 1, 2019.
  • December 31

    Early Intensive Developmental and Behavioral Intervention (EIDBI)

  • Early Intensive Developmental and Behavioral Intervention (EIDBI) billing grid – We posted the new EIDBI billing grid that is effective Jan. 1, 2019.
  • December 26

    Provider Basics
    Billing Policy (Overview)

  • Paper Claim Submission Policies – Removed link to information about submitting paper authorizations since authorizations must be submitted to the review agents.
  • December 17

    Early Intensive Developmental and Behavioral Intervention (EIDBI) Benefit

  • EIDBI Billing Grid – Added information that details the number of hours a clinician can provide for individual intervention EIDBI services.
  • December 14

  • MHCP Member Evidence of CoverageWe updated the list of services covered under substance use disorder services (formerly chemical dependency services).
  • December 10

    Individualized Education Program (IEP) Services

  • Speech and Language Pathology and Audiology Services – Clarified coverage for Speech Language Pathology and Audiology IEP evaluations, re-evaluations and assessments. Providers may bill for assessments that are health-related and conducted for the sole purpose of identifying the health needs of the child for the child’s IEP or IFSP even if the assessment does not result in an IEP.
  • December 7

    Reproductive Health/OB-GYN

  • Abortion Services – Under the billing section corrected abortion CPT code S0901 to S0191 (misoprostol).
  • December 6

    Physician and Professional Services

  • Physician and Professional Services – Updated with the correct reporting and discarding information of administered drugs with using the JW modifier under the Reporting the Discarded Portion of Administered Drugs section. Physician Services in Teaching Settings section added for teaching guidelines. "Recipient" was updated to "member" throughout this section.
  • EW and 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 and Noncovered Services sections: Homemaker, Respite Care, and Specialized Equipment and Supplies. We revised the Residential Care Services subsection; this service was discontinued effective July 1, 2018, although claims from before this date may still be submitted if within the one-year claim submission for timely billing.
  • RSC-TCM

  • • In Covered Services, we added links to RSC-TCM and VADD-TCM sections of the Community-Based Services Manual (CBSM) and the MH-TCM section of the MHCP Provider Manual.
  • • Under Authorization Requirements, we clarified that for Waiver Transitional Services, a service provider may simultaneously provide waiver transitional services and RSC-TCM to an eligible member who meets the requirements and limitations for waiver transitional services.
  • • Under Billing, we deleted procedure code T1016 because it is no longer valid.
  • December 3

    Clinic Services

  • Clinic Services – Added description for CPT guidelines in the Billing for PHNC Services table.
  • Previous 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

    Rate/Report this pageReport/Rate this page

    © 2019 Minnesota Department of Human Services Updated: 2/13/19 1:30 PM | Accessibility | Terms/Policy | Contact DHS | Top of Page | Updated: 2/13/19 1:30 PM