Coronavirus (COVID-19)
The state and federal COVID-19 public health emergencies have ended.
Overview
The peacetime emergency declared by Governor Walz and the public health emergency declared by the U.S. Department of Health and Human Services necessitated the temporary modifications listed in this manual section. All covered services and policy modifications listed in this COVID-19 manual page were time limited.
Both the Minnesota peacetime emergency and the federal public health emergency have ended. Refer to the specific services sections of the Minnesota Health Care Programs (MHCP) Provider Manual for information on services that are covered now that the public health emergencies have ended.
Eligible Providers
Providers Using Telehealth
This policy change will continue after the COVID-19 public health emergency ends and is now in the Telehealth Services, Telehealth Delivery of Substance Use Disorder Services, Telehealth Delivery of Mental Health Services, Covered and Noncovered IEP Health-Related Services and the Early Intensive Developmental and Behavioral Intervention (EIDBI) Benefit sections of the MHCP Provider Manual.
Legislative changes made to telehealth allow all eligible MHCP providers currently enrolled with the Telehealth Provider Assurance Statement (DHS-6806) (PDF) to continue providing services via telehealth beyond the public health emergency. The following applies to providers who want to provide and bill for services via telehealth:
MHCP will not accept new Telephonic Telemedicine Provider Assurance Statement (DHS-6806A) submissions beginning Feb. 1, 2022. You must submit the Telehealth Provider Assurance Statement (DHS-6806) (PDF) to be eligible to provide services via telehealth beginning June 1, 2022. Providers who were enrolled with the Telephonic Telemedicine Provider Assurance Statement (DHS-6806A) can bill retroactively for up to one year for services provided via telehealth on or before May 31, 2022.
Audio-only continues to be an allowable telehealth modality until July 1, 2025.
Providers eligible to provide telehealth include the following (also includes any equivalent tribal providers):
Additionally, psychiatric care providers in Assertive Community Treatment (ACT) and Intensive Rehabilitative Mental Health Services (IRMHS) are eligible to provide telehealth service via audio only.
Providers Eligible to Administer COVID-19 Vaccines
The following MHCP-enrolled provider types are eligible to bill for the administration of COVID-19 vaccines:
The following list of health care providers and students in a health care profession not enrolled in MHCP are approved to administer COVID-19 vaccines using the National Provider Identifier (NPI) of the MHCP-actively enrolled supervisor or organization (who qualifies in the previous category):
Providers must keep documentation on who administered the COVID-19 vaccine if a supervisor or organization is listed as the rendering or treating provider for auditing purposes.
Covered Services Changes and Modifications
COVID-19 Testing
Testing for Uninsured under New MA Group (Major program TT)
This MA coverage group (Major program TT) is effective May 1, 2020, and ends May 11, 2023, with the end of the federal public health emergency.
The Minnesota Legislature authorized a new Medical Assistance (MA) coverage group for those who are uninsured to cover testing and diagnosis of COVID-19. This change eliminates the financial barriers that might prevent someone who needs testing for COVID-19 from seeking care, increasing public health risks.
Effective March 18, 2021, uninsured individuals eligible for this program may also receive access to vaccines and treatment related to COVID-19.
MA coverage for COVID-19 covers testing, vaccines and treatment services related to COVID-19. This includes coverage for the COVID-19 test, serological tests and the office visit during which the test was given. There are no copays or deductibles for COVID-19 testing and treatment.
To be eligible for coverage, a person must be uninsured, must be a U.S. citizen, U.S. national or in a Medicaid qualifying immigration status. No requirements for age, income or assets apply for coverage of COVID-19 testing. A person is still eligible for MA coverage for COVID-19 testing if they have access to other health insurance, as long as the person is not actually enrolled in the other health insurance.
Fee-for-service providers:
Information on eligibility status will be available in the Eligibility Verification System (EVS) within 10 days of submission of the application.
Uninsured individuals are encouraged to complete the appropriate Minnesota Health Care Programs (MHCP) application. Any other MHCP program for which they become eligible will override the COVID-19 limited MA benefits.
Testing Ordered and Administered by Enrolled Pharmacists (ends May 11, 2023)
The Public Readiness and Emergency Preparedness (PREP) Act authorizes pharmacists to order and administer COVID-19 tests that the Food and Drug Administration has approved and preempts any state or local requirement that prohibits pharmacists from ordering or administering these diagnostic tests. The Minnesota Board of Pharmacy has issued guidance in their COVID-19 Frequently Asked Questions online document regarding this change and the professional requirements surrounding the newly expanded authority for pharmacists. As a result of the PREP Act, DHS will now reimburse pharmacists for ordering and administering COVID-19 tests. Refer to Enrolled Pharmacists Ordering and Administering COVID-19 Testing for billing information.
Testing Ordered and Administered by Enrolled Dentists
The Public Readiness and Emergency Preparedness (PREP) Act authorizes dentists to order and administer COVID-19 tests that the Food and Drug Administration has approved and preempts any state or local requirement that prohibits dentists from ordering or administering diagnostic tests. Refer to the American Dental Association Guidance on COVID-19. Dentists who administer COVID-19 or other microbe testing must be enrolled with CLIA (Clinical Laboratory Improvement Amendments). Any dental practice that performs tests on human tissue (including saliva, plaque, blood or hard or soft tissue) must comply with CLIA regulations. Dentists wishing to obtain CLIA enrollment should contact:
Minnesota Department of Health
CLIA Program
P.O. Box 64900
St Paul, MN 55164-0900
Phone: (651) 201-4120
Email: health.clia@state.mn.us
Over-the-counter COVID tests (ends Sept. 30, 2024)
Over-the-counter COVID-19 tests are a covered benefit according to sections 9811 and 9821 of the American Rescue Plan Act of 2021. MHCP allows 8 tests to be dispensed per month per member. Tests may be dispensed on the same date. Additional tests can be dispensed with prior authorization. Refer guidance issued by the Centers for Medicare & Medicaid Services #SHO 21-003 for more information.
MHCP covers over-the-counter (OTC) antigen tests and polymerase chain reaction (PCR) tests. Bill tests as a durable medical equipment (DME) and supplies benefit. OTC tests can be dispensed by any provider that is eligible to bill MHCP as a DME supplier (including any pharmacies that are enrolled). MHCP requires a prescription. Prescriptions can come from approved licensed professionals within the scope of their practice according to DME policy as well as pharmacists (according to the PREP Act).
We will not reimburse members who purchase OTC tests. OTC tests must be billed through MHCP at the time of dispensing.
COVID-19 Vaccines
Members in most MHCP major programs, including Minnesota Family Planning Program (MFPP), are eligible for COVID-19 vaccines. Some COVID-19 vaccine services are extended under the Emergency Use Authorization. Refer to the Immunizations and Vaccinations section of the Provider Manual for ongoing coverage.
Customized Living Rate Add-On for EW, CADI or BI
The DHS Commissioner authorized add-on payments under Minnesota Statutes, 12.A.10. These payments are available to eligible customized living providers serving people in the Elderly Waiver (EW), Community Alternative for Disability Inclusion (CADI), or Brain Injury (BI) waiver programs to help cover additional costs associated with COVID-19.
DHS will provide a 50 percent rate add-on for customized living services for 45 days, beginning the date the provider setting had at least one COVID-19 exposure–as determined by the Minnesota Department of Health (MDH). This rate add-on is available to providers delivering services in a setting that has had at least one confirmed COVID-19 case among its residents or staff between Mar. 13, 2020, and July 31, 2020. Refer to the Changes to COVID-19 rate add-on policy for customized living providers for more information.
The application deadline for this program was Sept. 30, 2020. After Sept. 30, 2021, DHS plans to end payments for this program. Refer to Payments end for COVID-19 customized living rate add-on for more details.
Early Intensive Developmental Behavioral Intervention (EIDBI) Individual Treatment Plans
The following waiver expired on July 1, 2021, with the end of the state peacetime emergency declared by the governor. The effective date time frame for this waiver was Mar. 13, 2020, to June 30, 2021.
Existing individual treatment plans will remain in effect beyond their current renewal timelines effective Mar. 13, 2020. You can continue to provide Early Intensive Developmental Behavioral Intervention services without a progress monitoring update. You can submit existing treatment plans for continued authorization to the medical review agent or pre-paid health plan.
HCBS Waiver Services
Remote Delivery of HCBS Waiver Services
Effective Jan. 1, 2022, remote delivery of HCBS Waiver Services became permanent. To review the remote support policy information and definition for applicable services, see Remote Support in the Community-Based Services Manual (CBSM).
Effective Mar. 19, 2020, DHS will allow remote support (real-time, two-way communication) temporarily as a service delivery option for several Home and Community Based (HCBS) waiver services. Providers may deliver services remotely through phone or other interactive technology medium. Remote delivery of HCBS waiver services is not the same as telehealth. Providers cannot use telehealth to deliver HCBS waiver and Alternative Care services.
Providers may use remote support for people who live in a single-family home or apartment and for people who live in provider-controlled residential settings (such as corporate adult foster care, family foster care, customized living).
The affected programs are:
Services provided through remote support must be the same as or similar to functions of the existing services authorized in the person’s support plan.
Visit the Remote Support section of the HCBS Programs Provider Enrollment section of the MHCP Provider Manual to find out more about remote delivery of specific services.
Billing requirements for HCBS waiver services have not changed.
If you wish to continue to provide Remote Support after the end of the federal public health emergency, please refer to Home and Community-Based Services (HCBS) Programs Provider Enrollment section.
Adult Day Services
On May 4, 2020, the DHS commissioner authorized licensed adult day service providers to provide services in alternative ways during the COVID-19 peacetime emergency. This was referred to as “Alternative adult day.” As of June 30, 2023, Alternative adult day service authority under the COVID-19 peacetime emergency ended.
This change means providers can deliver adult day services using the following methods:
Providers can deliver the following services in alternative ways:
Service limits for alternative delivery of adult day services include the following:
The 2022 Legislature approved a permanent option for remote adult day services for licensed adult day service providers beginning July 01, 2023. See the Community Based Services Manual (CBSM) Adult Day Services page for updated policy information for remote adult day services.
Adult Day Center Licensing Requirements Modifications
This modification that was in effect during the state peacetime emergency expired on May 28, 2021. The effective date time frame for this waiver was Oct. 16, 2020, to May 27, 2021.
Effective Oct. 16, 2020, the commissioner amended the temporary modification of certain licensing requirements that allowed providers of adult day centers to conduct in-person group services. The changes are necessary to recognize that individuals served have a right to make an informed choice about whether to receive group services in a licensed setting.
The modification on Oct. 16, 2020, increases the maximum duration that a person can receive in-person, group-based adult day services in one day from four hours to six hours and increases providers’ flexibility in providing these services. Providers can now choose whether to deliver services in one continuous shift not to exceed six hours or two shifts not to exceed four hours for each shift. A person receiving services can only attend one shift.
The license holders must:
Stay up to date with changes by reviewing the Licensing help for adult day providers webpage.
Hearing Aid Services
The following expired for dates of service after May 11, 2023. The effective date time frame for this telehealth coverage was Sept. 1, 2022, to May 11, 2023.
Effective Sept. 1, 2022, MHCP will temporarily cover programming and reprogramming of cochlear implants for ages 12 years and older done via telehealth. You must complete and submit a Telehealth Provider Assurance Statement (DHS-6806) (PDF) to be eligible for reimbursement for services provided via telehealth.
Home Care and PCA Services
Remote Delivery for PCA Services
The Minnesota Legislature extended remote delivery for Qualified Professional visits through Aug. 30, 2021.The effective date time frame for this waiver was March 19, 2020, to Aug. 30, 2021.
The Minnesota Legislature reinstated remote delivery for Qualified Professional visits, effective retroactively beginning Sept. 1, 2021, and going through June 30, 2022.
Two modifications to PCA services are to:
These changes affect QP supervision of PCA services authorized through:
Remote delivery of qualified professional services allows QPs to provide:
For services delivered remotely, the QP also must document:
See the PCA Manual – Covered Services for permanent PCA services policy.
IEP Personal Care Assistance in the Child’s Home
The Minnesota Legislature approved this policy change to become permanent. Refer to the IEP Services section of the MHCP Provider Manual.
The commissioner has approved a waiver that will temporarily allow MHCP to reimburse for Individualized Education Program (IEP) personal care assistance (PCA) services in a child’s home during distance learning. The child must have a current Individualized Education Program (IEP) or Individualized Family Service Plan (IFSP) that identifies the child’s need for the PCA service that is based on their current plan of care and time study.
Schools should continue to follow the covered and noncovered criteria, recordkeeping and documentation that is outline in the IEP Personal Care Assistance (PCA) Services section of the MHCP Provider Manual.
Family Members Providing PCA Services for MHCP-Enrolled Members
Family members described in the following text are allowed to provide personal care assistance (PCA) beginning July 1, 2021, and ending November 11, 2023.
The Minnesota Legislature reinstated this waiver, which was effective during the dates of Dec. 1, 2020 – Feb. 7, 2021, during the state peacetime emergency. Minnesota Health Care Programs (MHCP) will temporarily waive the restriction on allowing certain family members to provide and receive payment for personal care assistance services to MHCP-enrolled PCA members. The intent of this waiver is to reduce the spread of COVID-19 by reducing the need for additional PCA providers to enter the home to provide PCA services during the pandemic.
This waiver, effective again starting July 1, 2021, allows the following types of family members of individuals enrolled in MHCP to receive PCA services to be eligible to provide PCA care:
PCA agencies can bill for services provided by one of the family members listed in the previous bullets from Dec. 1 – Feb. 7, 2021, or after July 1, 2021, until November 11, 2023. PCA agencies cannot bill for any services provided by one of the family members previously listed when this waiver was not in effect, from Feb. 8 – June 30, 2021, or after November 11, 2023.
The family member must enroll in MHCP using the same process as for other individual PCA providers to provide PCA services to their relative and receive payment for the care. PCA providers will inform the family members of the PCA members they serve that they can apply to provide PCA services during the waiver effective dates and instruct them on the enrollment process.
PCA agencies must only seek to enroll a family member as a worker who is not the person’s responsible party. See the enrollment requirements outlined for individual PCA providers in the MHCP Provider Manual.
Interfacility Transport during COVID-19
This waiver expired for dates of service on or after Sept. 1, 2021. The effective date time frame for this waiver was Sept. 1, 2020, to Aug. 31, 2021.
Effective Sept. 1, 2020, Medical Assistance and MinnesotaCare covers ambulance services for transferring members between hospitals in order to maintain capacity to treat incoming patients. Hospitals needing to transfer members between facilities to maintain capacity must document the lack of capacity, type of capacity created, which facility they selected, and why they selected that facility in order to justify the transport. Services must be medically necessary and the original facility to which the member was transported is either not equipped to provide the treatment or needs to maintain their appropriate patient capacity.
Medications, Vaccines and Devices
This policy change ends May 11, 2023
Investigational Drugs, Vaccines, Devices and Associated Services
Effective Nov. 11, 2020, the Minnesota Department of Human Services’ (DHS) commissioner allowed Medical Assistance and MinnesotaCare members to receive coverage for investigational drugs, vaccines, devices and associated services that receive federal approval under an Emergency Use Authorization to treat or prevent COVID-19. Current state law prohibits Medical Assistance and MinnesotaCare coverage for investigational drugs, vaccines, devices and associated services.
Providers may not seek reimbursement for any investigational drug, vaccine, or device that a federal distribution program provides at no cost. This change accomplishes the following:
It ensures Minnesota receives the enhanced federal funding available under the Families First Coronavirus Response Act by meeting the requirement for Medicaid agencies to cover all COVID-19 treatments.
90-Day Supply for Certain Medications
The Minnesota Legislature approved this policy change to become permanent. Refer to the Pharmacy Services section of the MHCP Provider Manual.
Effective April 2, 2020, MHCP has temporarily increased the prescription drug coverage limit for certain therapeutic non-controlled drug classes to a 90-day supply for all fee-for-service Medical Assistance and MinnesotaCare members. This change will remain in effect until the peacetime emergency is terminated.
DHS is not mandating that a 90-day supply of these medications be dispensed. Prescribers and pharmacists are expected to continue to use their professional and clinical judgment as to the appropriate quantity to dispense to members.
Claims for medications affected by this change do not require an override from the DHS Provider Call Center. Overrides may be available from the Provider Call Center for medications not included in this initiative when the member has another insurance that has covered a 90-day supply of the medication. This extension for prescriptions applies to the fee-for-service pharmacy benefit. The managed care organizations (MCOs) may implement a 90-day supply program and you can obtain the details of those programs from the MCOs.
COVID-19 and Influenza Vaccine Administration
This policy change ends May 11, 2023.
The Public Readiness and Emergency Preparedness (PREP) Act authorizes pharmacists to administer COVID-19 and influenza vaccines for children ages three through 18 years old through December 31, 2024. As a result of the PREP Act, DHS will reimburse pharmacists for administering COVID-19 and influenza vaccines consistent with the PREP Act requirements. See Pharmacists Ordering and Administering COVID-19 and Influenza Vaccines for billing information.
Targeted Case Management
This policy change will continue after the COVID-19 public health emergency ends and is now in the Child Welfare Targeted Case Management and Adult Mental Health Targeted Case Management and Children’s Mental Health Targeted Case Management sections of the MHCP Provider Manual.
The change, effective starting Mar. 19, 2020, allows case managers to conduct targeted case management visits by phone or video with adults receiving services and with their legal guardians, and with children receiving services and their parents or legal guardians.
Bill all TCM services following the billing instructions under Targeted Case Management under Billing in this manual section. TCM providers do not need to meet the telehealth standards and do not need to submit a Telehealth Provider Assurance Statement (DHS-6806) (PDF) because telehealth does not apply to TCM.
The affected programs include:
This change means that Indian Health Service (IHS), Sec. 638 tribal providers, may receive the daily encounter payment when the contact between the case manager and the person receiving services happens by telephone instead of through an in-person, face-to-face visit.
Although the mode of how a service may be delivered is temporarily changing (for example, targeted case management services can be delivered via telephone temporarily), there are no changes to the payment methodology for the daily encounter payment. MHCP will require the same service providers who are required to generate a daily encounter payment to continue to do so when they deliver targeted case management services while this waiver is in effect.
Telehealth
Expanded Telehealth Coverage
This policy change will continue after the COVID-19 public health emergency ends and is now in the Telehealth Services, Telehealth Delivery of Substance Use Disorder Services, Telehealth Delivery of Mental Health Services, Covered and Noncovered IEP Health-Related Services and the Early Intensive Developmental and Behavioral Intervention (EIDBI) Benefit sections of the MHCP Provider Manual.
The following telehealth (formerly telemedicine) changes are effective for dates of service on and after Mar. 19, 2020:
In delivering telehealth, including via audio only (telephone), the distant site (provider’s location) can be the eligible provider’s home. The originating site (member’s location) can be the member’s home. Refer to the Telehealth Services section of the MHCP Provider Manual for additional information on telehealth services coverage.
Providers cannot use telehealth to deliver Home and Community-Based Services (HCBS) waiver and Alternative Care (AC) services. See Remote Delivery of HCBS Waiver Services for more information about delivering HCBS services remotely during the COVID-19 pandemic. Case managers and care coordinators may review the Case management/Care coordination section of the Community-Based Services Policy Manual for updated policy and procedures to ensure continuity of care for people in Minnesota who access HCBS waiver and Alternative Care services.
Store-and-Forward Telehealth for IEP Services
This policy change will continue. Refer to the Telehealth Services for IEP section of the MHCP Provider Manual.
Effective Aug. 1, 2020, MHCP will allow Minnesota public schools enrolled to provide Individualized Education Program (IEP) services and also approved to provide telehealth (formerly telemedicine) services, to use store-and-forward telehealth when a child is distance learning at home for the following services:
Store-and-forward telehealth is asynchronous, non-real-time communications. Service providers and members transfer data from one site to another via camera or similar device that records (stores) an image and forwards it by telecommunications to another site for consultation. It can be used to support health care delivery, including sending and receiving health-related instructions, activities or tasks that are identified in the child’s Individualized Education Plan (IEP) or Individualized Family Service Plan (IFSP) that are necessary to maintain, restore or improve functions related to the child’s disability. Real-time, two-way interactive video with the school professional and child or parent must accompany the store-and-forward telehealth component.
Use the store-and-forward method only when a child is distance learning at home. When a child is attending school in person, the school must provide IEP services either in person, or via two-way, interactive video conference.
IEP nursing services, special transportation, assistive technology and personal care assistance (PCA) services are not eligible for store-and-forward telehealth.
Changes in Requirements
Documentation
The following waiver expired for dates of service on or after Sept. 1, 2021. The effective date time frame for this waiver is Apr. 17, 2020, to Aug. 31, 2021.
Effective Apr. 17, 2020, a signature from the member or authorized representative is not required for proof of delivery for durable medical equipment and supplies. The remainder of the proof of delivery policy covered under the Equipment and Supplies section of this manual remains in effect. MHCP requires providers to maintain documentation that the equipment or supply was successfully delivered to the member.
The following waiver expired for dates of service on or after Sept. 1, 2021. The effective date time frame for this waiver is Apr. 17, 2020, to Aug. 31, 2021.
Effective Apr. 17, 2020, nonemergency medical transportation providers are not required to obtain a signature from the member or authorized party to certify the transport occurred. All other documentation requirements continue to apply and providers are required to ensure appropriate documentation that substantiates the delivery of the transport.
The following case note documentation requirement expired for dates of service after May 11, 2023. The effective date time frame for the case note documentation requirement is March 19, 2020, to May 11, 2023.
Effective Mar. 19, 2020, for targeted case management auditing purposes, document in the agency’s case-noting system which method of delivery, telephone or video-conferencing, was used instead of in-person face-to-face contact for purposes of COVID-19. The department has the authority to conduct a post-payment review of client files.
This policy change ended May 11, 2023, with the end of the federal public health emergency.
Effective Mar. 20, 2020, providers may accept verbal consent in lieu of written consent for individual treatment plans during the COVID-19 Peacetime Emergency for the following services:
Providers must document and maintain in the client file the name of the person providing consent, relationship to the client, and date verbal consent was obtained.
Recertification
This waiver expired Aug. 30, 2021.
DHS temporarily waived recertification for providers of the following services from March 20, 2020, to August 30, 2021:
Contact the Behavioral Health Division (BHD) at dhs.ma.behavioral.health@state.mn.us or call 651-431-2225 regarding your certification timelines and options. We will not automatically extend your services. You will need to contact BHD to initiate a COVID-19 recertification extension approval.
ITFC, DBT, ACT and ARMHS providers
If your certification expired on or after Mar. 20, 2020, you have until Aug. 30, 2021, to recertify.
Revalidation
Starting on Aug. 15, 2022, Minnesota Health Care Programs (MHCP) will resume revalidation in phases. Refer to Provider Screening Requirements in the MHCP Provider Manual for more information on revalidation.
Providers due for revalidation will receive a revalidation notice in their MN–ITS PRVLTR folder. If you have not set up a MN–ITS mailbox, we will mail your notice of revalidation to the credentialing address on your enrollment record.
Do not send revalidation documents until you receive your revalidation notice.
Sign up for the Minnesota Provider Screening and Enrollment (MPSE) portal training to learn how you can complete your revalidation online using the MPSE portal.
Billing
Children’s Therapeutic Services and Supports (CTSS)
The following two billing changes were effective for dates of service Aug. 21, 2020, through May 11, 2023, for certified day treatment providers of CTSS.
Cost Sharing Changes
Effective Jan. 1, 2020, through Jan. 1, 2024, all services for diagnosis and treatment of COVID-19 are exempt from cost sharing. Providers do not need to take any action for this when billing for services. For more information on how cost sharing works, consult the Billing the Member section of this manual. DHS will reprocess claims submitted before we implemented this change.
COVID-19 Testing
Uninsured under New MA Group
Effective May 1, 2020, through Sept. 30, 2024, bill DHS through MN–ITS on a fee-for-service basis for uninsured people eligible for MA coverage for COVID-19 testing and the office visit during which the test was given.
Enrolled Pharmacists Ordering and Administering COVID-19 Testing
Use procedure codes G2023 and G2024 when billing for ordering and administering the COVID-19 tests. Claims for ordering and administering COVID-19 tests must be billed on an 837P professional claim using the enrolled pharmacist’s National Provider Identifier (NPI) as the ordering and rendering provider and the pharmacy’s NPI as the pay-to provider.
Enrolled Dentists Ordering and Administering COVID-19 Testing
MHCP will only reimburse dentists enrolled with CLIA (Clinical Laboratory Improvement Amendments) for administering COVID-19 tests. Eligible dental providers should use the following procedure code on claims for administering COVID-19 tests to members:
See the ADA’s COVID-19 and Lab Testing Requirements Toolkit for additional information.
See the Dental Services section of the Provider Manual for ongoing coverage.
Over-the-Counter COVID-19 Tests (ends Sept. 30, 2024)
MHCP allows 8 tests to be dispensed per month per member. Tests may be dispensed on the same date. Additional tests can be dispensed with prior authorization. Billing with a date span is not allowed. Bill using HCPCS code T5999 for tests dispensed before July 1, 2022. Use HCPCS code K1034 for tests dispensed on or after July 1, 2022. Use MN–ITS 837P Professional or X12 Batch.
Hearing Aid Services
This billing change was effective for dates of service Sept. 1, 2022, through May 11, 2023.
Bill for cochlear implants programming and reprogramming services performed via telehealth using CPT codes 92603 and 92604 as described in the American Medical Association CPT guide. Refer to the Billing section of Telehealth Services in the MHCP Provider Manual for information on billing for telehealth.
IEP Personal Care Assistance in the Child’s Home
This policy change will continue after the COVID-19 peace time emergency and is in the IEP Personal Care Assistance (PCA) Services section (refer to Noncovered Services) under IEP Services in the MHCP Provider Manual.
We have changed our billing system to allow schools to bill for Individualized Education Program (IEP) Personal Care Assistance (PCA) services when the services are provided in the home. Use place of service as “home” when the child is distance learning Any claims that were submitted using place of service as “school” and documenting that the actual place of service was “home,” must be replaced with the correct place of service. Contact the MHCP Provider Resource Center if you have questions.
Increase in Billing Hours for Individual PCA Services
This policy change will continue after the COVID-19 peace time emergency and is now in the PCA policy manual section.
DHS has modified the MMIS claims system to allow for the increase from 275 hours to 310 hours per month, per individual PCA worker, effective for service dates starting on May 1, 2020. Bill for the allowed additional hours for individual PCA services using the same billing procedure as before. DHS is reprocessing claims submitted and denied due to 275-hour limit before the MMIS claims system modification was in place and we will issue those payments in the July 7, 2020, remittance advice.
Refer to PCA Manual – Covered Services for permanent PCA services policy.
Targeted Case Management
The effective date time frame for these billing instructions is March 19, 2020, through May 11, 2023. Billing instructions for dates of service beginning May 12, 2023, can be found in the Child Welfare Targeted Case Management and Adult Mental Health Targeted Case Management and Children’s Mental Health Targeted Case Management sections of the MHCP Provider Manual.
Effective Mar. 19, 2020, through May 11, 2023, enter claims as normal in MN–ITS Direct Data Entry (DDE). However, when making a TCM claim for a telephone or video-conferencing contact instead of in person face-to-face contact, use the appropriate face-to-face procedure code and modifier.
Telehealth
The effective date time frame for these billing instructions is March 19, 2020, through May 31, 2022. Billing instructions for services provided via telehealth beginning June 1, 2022, can be found in the Telehealth Services, Telehealth Delivery of Substance Use Disorder Services, Telehealth Delivery of Mental Health Services, Covered and Noncovered IEP Health-Related Services and the Early Intensive Developmental and Behavioral Intervention (EIDBI) Benefit sections of the MHCP Provider Manual.
To bill for services via telehealth or telephonic (audio-only) telehealth, providers must have documentation of services provided and have followed all clinical standards.
Refer to the Telehealth Services section of the MHCP Provider Manual under Billing to bill for services provided via telehealth effective June 1, 2022.
Telephonic telehealth providers:
You may provide and bill services via telehealth under Telephonic Telemedicine Provider Assurance Statement (DHS-6806A) only through May 31, 2022. Do not bill place of service 02. Continue to bill as usual (the same way as services delivered in person) and use modifier 95 to indicate you provided the service via audio only (telephonic).
Providers who receive encounter payments:
Audio-only communication for the following policy will end July 1, 2025
Effective Mar. 19, 2020, Indian Health Service, tribal 638 clinic, Federally Qualified Health Center and Rural Health Clinic telehealth services (including telephonic) will be included for the purposes of the face-to-face encounter payment methodology. Any service when provided face-to-face that would generate an encounter if performed in person will continue to generate an encounter if provided via telehealth, including telephone and televideo, as long as it meets all applicable telehealth requirements.
Vaccines
COVID-19 Vaccine Billing Instructions
Pharmacists Ordering and Administering COVID-19 and Pediatric Vaccines
Billing claims for administering COVID-19 vaccines ages 16 and older:
Billing claims for pediatric vaccines for children ages 3 through 18 years old
Note: The MnVFC program is not currently distributing the COVID-19 vaccines approved by the Food and Drug Administration under an Emergency Use Authorization. Pharmacists may not seek reimbursement for any vaccine that a federal distribution program provides at no cost; however, MHCP will reimburse the cost for the administration of the vaccines.
See the Pharmacy Services section of the Provider Manual for ongoing coverage.
COVID-19 Vaccine Provided in a Home Setting
MHCP will follow Medicare’s updated payment policy for administering the COVID-19 vaccine in the home if administering a COVID-19 vaccine is the only service performed at that time. Bill the appropriate administration code for the vaccine with place of service 12. Providers are not eligible for the additional amount if another MHCP service in the same home on the same date of service takes place. In those situations, MHCP pays for administering the COVID-19 vaccine at the standard amount.
If you administer the COVID-19 vaccine to more than one MHCP member in a single home in the same multi-unit or communal living arrangement on the same day, MHCP pays:
Providers must keep documentation on who administered the COVID-19 vaccine if a supervisor or organization is listed as the rendering or treating provider for auditing purposes.
See the Immunizations and Vaccinations section of the Provider Manual for ongoing coverage.
Dentists Ordering and Administering COVID-19 Vaccines
The American Dental Association has approved the following CDT codes for dentists to use for claims for administering COVID-19 vaccines. Dental providers must use the American Dental Association (ADA) Dental Claim Form. See the MHCP Fee Schedule for rates.
CDT Vaccine Administration Code | Vaccine Description | Eligible Ages | Effective Date | Discontinue Date |
D1701 | Pfizer-BioNTech COVID-19 vaccine administration – first dose SARS-CoV-2 COVID-19 VAC mRNA 30mcg/0.3ml intramuscular (IM) DOSE 1 | 5 years old and older | March 15, 2021 | July 1, 2022 |
D1702 | Pfizer-BioNTech COVID-19 vaccine administration – second dose SARS-CoV-2 COVID-19 VAC mRNA 30mcg/0.3ml IM DOSE 2 | 5 years old and older | March 15, 2021 | July 1, 2022 |
D1703 | Moderna COVID-19 vaccine administration – first dose SARS-CoV-2 COVID-19 VAC mRNA 100mcg/0.5ml IM DOSE 1 | 18 years old and older | March 15, 2021 | July 1, 2022 |
D1704 | Moderna COVID-19 vaccine administration – second dose SARS-CoV-2 COVID-19 VAC mRNA 100mcg/0.5ml IM DOSE 2 | 18 years old and older | March 15, 2021 | July 1, 2022 |
D1707 | Janssen COVID-19 vaccine administration – single dose SARS-CoV-2 COVID-19 VAC Ad26 5x1010 VP/.5ml IM SINGLE DOSE | 18 years old and older | March 15, 2021 | July 1, 2022 |
D1708 | Pfizer-BioNTech COVID-19 vaccine administration – third dose SARS-CoV-2 COVID-19 VAC mRNA 30mcg/0.3ml IM DOSE 3 | 5 years and older | March 22, 2022 | July 1, 2022 |
D1709 | Pfizer-BioNTech COVID-19 vaccine administration – booster dose SARS-CoV-2 COVID-19 VAC mRNA 30mcg/0.3ml IM DOSE BOOSTER | 12 years and older | March 22, 2022 | July 1, 2022 |
D1710 | Moderna COVID-19 vaccine administration – third dose SARS-CoV-2 COVID-19 VAC mRNA 100mcg/0.5ml IM DOSE 3 | 18 years and older | March 22, 2022 | July 1, 2022 |
D1711 | Moderna COVID-19 vaccine administration – booster dose SARS-CoV-2 COVID-19 VAC mRNA 50mcg/0.25ml IM DOSE BOOSTER | 18 years and older | March 22, 2022 | July 1, 2022 |
D1712 | Janssen COVID-19 vaccine administration – booster dose SARS-CoV-2 COVID-19 VAC Ad26 5x1010 VP/.5ml IM DOSE BOOSTER | 18 years and older | March 22, 2022 | July 1, 2022 |
D1713 | Pfizer-BioNTech COVID-19 vaccine administration tris-sucrose pediatric – first dose SARS-CoV-2 COVID-19 VAC mRNA 10mcg/0.2ml tris-sucrose IM DOSE 1 | 5 -11 years old | March 22, 2022 | July 1, 2022 |
D1714 | Pfizer-BioNTech COVID-19 vaccine administration tris-sucrose pediatric – second dose SARS-CoV-2 COVID-19 VAC mRNA 10mcg/0.2ml tris-sucrose IM DOSE 2 | 5 -11 years old | March 22, 2022 | July 1, 2022 |
COVID-19 Vaccine and Administration Codes
The American Medical Association approved the following CPT codes and providers can bill using these codes as of the effective dates listed. MHCP does not require the use of COVID-19 CPT vaccine codes and considers these codes as informational only. See the MHCP Fee Schedule for CPT administration codes rates. The following COVID-19 vaccines have Emergency Use Authorization which is separate from the public health emergency.
CPT Vaccine Code | Vaccine Description | Eligible Ages | Effective Date | Discontinued Date |
91300 | SARS-CoV-2 VAC 30mcg/0.3ml IM | 16 years and older 12 years and older | Dec. 11, 2020 May 10, 2021 | April 18, 2023 April 18, 2023 |
91301 | SARS-CoV-2 VAC 100mcg/0.5ml IM | 12 years and older | Dec. 18, 2020 | April 18, 2023 |
91305 | SARS-CoV-2 VAC 30 mcg/0.3 ml IM | 12 years and older | Jan. 3, 2022 | April 18, 2023 |
91306 | SARS-CoV-2 VAC 50 mcg/0.25 ml IM | 65 years and older; and others with certain conditions | Oct. 20, 2021 | April 18, 2023 |
91307 | SARS-CoV-2 VAC 10 mcg/0.2 ml IM | 5 -11 years old | Oct. 29, 2021 | April 18, 2023 |
91308 | SARS-CoV-2 VAC 3 mcg/0.2 ml IM | 6 months - 4 years | June 17, 2022 | April 18, 2023 |
91309 | SARS-CoV-2 VAC 50 Mcg/0.5 ml IM | 18 years and older | March 29, 2022 | April 18, 2023 |
91311 | SARS-CoV-2 VAC 25MCG/0.25ml IM | 6 months - 5 years | June 17, 2022 | April 18, 2023 |
CPT Administration Code | Vaccine Administration Description | Use With | Effective Date | DiscontinuedDate |
0001A (Discontinued Apr. 18, 2023) | Report the administration of vaccine only for 91300 (Pfizer-BioNTech): Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3ml dosage, diluent reconstituted; first dose | Report 0002A for second dose Report 0003A for third dose Report 0004A for the booster dose | Dec. 11, 2020 Aug. 12, 2021 Sept. 22, 2021 | April 18, 2023 April 18, 2023 April 18, 2023 |
0011A Discontinued April 18, 2023 | Report the administration of vaccine only for 91301 (Moderna): Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100mcg/0.5ml dosage; first dose | Report 0012A for second dose Report 0013A for third dose | Dec. 18, 2020 Aug. 12, 2021 | April 18, 2023 April 18, 2023 |
0051A | Report the administration of vaccine only for 91305 (Pfizer): Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, tris-sucrose formulation; 30 mcg/0.3 ml dosage, first dose | Report 0052A for second dose Report 0053A for third dose Report 0054A for booster dose (For emergency use only of individuals 18 years and older) | Jan. 3, 2022 Jan. 3, 2022 Jan. 3, 2022 | April 18, 2023 April 18, 2023 April 18, 2023 |
0064A | Report the administration of vaccine only for 91306 (Moderna): Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 50 mcg/0.25 ml dosage, booster dose | Single booster dose | Oct. 20, 2021 | April 18, 2023 |
0071A | Report the administration of vaccine only for 91307 (Pfizer-BioNTech): Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 10 mcg/0.2 ml dosage, diluent reconstituted, tris-sucrose formulation, for intramuscular use; first dose | Report 0072A for the second dose Report 0073A for the third dose Report 0074A for the booster dose | Oct. 29, 2021 Jan. 3, 2022 May 17, 2022 | April 18, 2023 April 18, 2023 April 18, 2023 |
0081A | Report the administration of vaccine only for 91308 (Pfizer-BioNTech): Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 3 mcg/0.2 ml dosage, diluent reconstituted, tris-sucrose formulation; first dose | Report 0082A for the second dose Report 0083A for the third dose | June 17, 2022 June 17, 2022 | April 18, 2023 April 18, 2023 |
0091A | Report the administration of vaccine only for 91309 (Moderna): Immunization administration by intramuscular injection of severe acute Respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 50 mcg/0.5 ml dosage; first dose | Report 0092A for the second dose Report 0093A for the third dose Report 0094A for the booster dose | June 17, 2022 June 17, 2022 July 6, 2022 | April 18, 2023 April 18, 2023 April 18, 2023 |
0111A | Report the administration of vaccine only for 91311 (Moderna): Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, mRNALNP, spike protein, preservative free, 25 mcg/0.25 ml dosage; first dose | Report 0112A for the second dose Report 0113A for the third dose | June 17, 2022 June 17, 2022 | April 18, 2023 April 18, 2023 |
Monoclonal Antibodies Administration Codes
Food and Drug Administration approved the following HCPCS codes and providers can bill using these codes as of the effective dates listed. See the MHCP Fee Schedule for HCPCS administration codes rates.
HCPCS Monoclonal Antibodies Code | Description | Eligible Ages | Effective Date | DiscontinuedDate |
M0220 | Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals with no known SARS-CoV-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available COVID-19 vaccine is not recommended due to a history of severe adverse reaction to a COVID-19 vaccines or COVID-19 vaccine components | 12 years and older | Dec. 8, 2021 | Jan. 26, 2023 |
M0221 | Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals with no known SARS-CoV-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available COVID-19 vaccine is not recommended due to a history of severe adverse reaction to a COVID-19 vaccines or COVID-19 vaccine components | 12 years and older | Dec. 8, 2021 | Jan. 26, 2023 |
M0222 | Intravenous injection, bebtelovimab, includes injection and post administration monitoring | 12 years and older | Feb. 11, 2022 | Nov. 30, 2022 |
M0223 | Intravenous injection, bebtelovimab, includes injection and post administration monitoring in the home or residence; this includes a beneficiary’s home that has been made provider-based to the hospital during the COVID-19 public health emergency | 12 years and older | Feb. 11, 2022 | Nov. 30, 2022 |
For more information about who can receive vaccinations, refer to the Minnesota Department of Health COVID-19 Vaccine Phases and Planning webpage and CDC Your COVID-19 Vaccination webpage.
Legal References
Minnesota Statutes, 256B.057, subdivision 12 (Presumptive eligibility determinations made by qualified hospitals)
Minnesota Statutes, 256B.0625 (Covered services)
Minnesota Statutes, 256B.0625, subdivision 3b (Telehealth Services)
Minnesota Statutes, 256B.0625, subdivision 64 (Investigational drugs, biological products, devices, and clinical trials)
Minnesota Statutes 256B.0631 (Medical Assistance Co-payments)
Minnesota Statutes, 256L.03, subdivision 5 (Cost-sharing)
Section 6004 of the Families First Coronavirus Response Act (Public Law 116-127) (COVID-19 Testing for Uninsured)
Laws of Minnesota 2020, Regular Session, Chapter 74, Article 1, Section 11 (COVID-19 Testing for Uninsured)
H.R.1319 - 117th Congress (2021-2022): American Rescue Plan Act of 2021 | Congress.gov | Library of Congress (COVID-19 Testing for Uninsured)
Public Readiness and Emergency Preparedness (PREP) Act, seventh amendment (allowing dentists to administer COVID-19 Vaccines)
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