Minnesota

At A Glance
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MEDICAID REIMBURSEMENT

  • Live Video: Yes
  • Store-and-Forward: Yes
  • Remote Patient Monitoring: Yes
  • Audio Only: Yes

PRIVATE PAYER LAW

  • Law Exists: Yes
  • Payment Parity: Yes

PROFESSIONAL REQUIREMENTS

  • Licensure Compacts: IMLC, PSY
  • Consent Requirements: Yes

STATE RESOURCES

  1. Medicaid Program: Medical Assistance
  2. Administrator: Minnesota Dept. of Human Services
  3. Regional Telehealth Resource Center: Great Plains Telehealth Resource and Assistance Center

Last updated 08/03/2022

Audio Only Delivery

Medicaid: COVID-19 and Telemedicine

STATUS: Active, various expiration dates. See page for further guidance.

Medicaid: Targeted Case Management Bulletin

STATUS: Expired

Medicaid: Early Intensive Developmental and Behavioral Intervention (EIDBI)

STATUS: Expired

Medicaid: Remote Support for Home and community based services waiver

STATUS: Expired

Medicaid: COVID-19 Telemedicine FAQs: Behavioral Health Division

STATUS: Active

Minnesota Department of Human Services: Alternative adult day service delivery due to COVID-19 pandemic

STATUS: Expired

Medicaid 1915(c) Waiver: Appendix K – Brain Injury Waiver, Community Alternative Care, (see document for all applicable waivers)

STATUS: Active, until six months after the end of the Federal PHE for COVID-19 (see extension below)

Medicaid 1915(c) Waiver: Appendix K – Brain Injury (BI) Waiver, Community Alternative Care (CAC) Waiver, Community Access for Disability Inclusion (CADI), Developmental Disabilities (DD) Waiver, and Elderly Waiver (EW)

STATUS: Active, until six months after the end of the Federal PHE for COVID-19 (see extension below)

Medicaid 1915(c) Waiver: Appendix K – Brain Injury (BI) Waiver, Community Alternative Care (CAC) Waiver, Community Access for Disability Inclusion (CADI), Developmental Disabilities (DD) Waiver, and Elderly Waiver (EW)

STATUS: Active, until six months after the end of the Federal PHE for COVID-19

HF 33 (2021 Session): Extends COVID-19 Telehealth Waivers

STATUS: Enacted (Audio-only allowance expires June 30, 2023)

Last updated 08/03/2022

Cross State Licensing

No Reference Found.

Last updated 08/03/2022

Easing Prescribing Requirements

No Reference Found.

Last updated 08/03/2022

Miscellaneous

1135 Waiver: Brain Injury (BI) Waiver, Community Alternative Care (CAC) Waiver, Community Access for Disability Inclusion (CADI), Developmental Disabilities (DD) Waiver, and Elderly Waiver (EW)

STATUS: Active, extends current waivers until six months after the end of the Federal PHE for COVID-19

HF 33 (2021 Session): Extends COVID-19 Telehealth Waivers

STATUS: Enacted (Audio-only allowance expires June 30, 2023)

Medicaid: COVID-19 Teleheath Provider Manual

STATUS: Active

Last updated 07/29/2022

Originating Site

Medicaid: COVID-19 and Telemedicine

STATUS: Active, various expiration dates. See page for further guidance.

Medicaid: Remote Support for Home and community based services waiver

STATUS: Expired

Medicaid: Store-and-forward telemedicine IEP services

STATUS: Active, this policy change will continue. See the Telemedicine Services section of IEP in the MHCP Provider Manual.

Minnesota Department of Human Services: Alternative adult day service delivery due to COVID-19 pandemic

STATUS: Expired

Medicaid 1915(c) Waiver: Appendix K – Brain Injury (BI) Waiver, Community Alternative Care (CAC) Waiver, Community Access for Disability Inclusion (CADI), Developmental Disabilities (DD) Waiver, and Elderly Waiver (EW)

STATUS: Active, until six months after the end of the Federal PHE for COVID-19

Medicaid 1915(c) Waiver: Appendix K – Brain Injury (BI) Waiver, Community Alternative Care (CAC) Waiver, Community Access for Disability Inclusion (CADI), Developmental Disabilities (DD) Waiver, and Elderly Waiver (EW)

STATUS: Active, extends current waivers until six months after the end of the Federal PHE for COVID-19

Last updated 08/03/2022

Private Payer

No Reference Found.

Last updated 08/01/2022

Provider Type

Medicaid: COVID-19 and Telemedicine

STATUS: Active, various expiration dates. See page for further guidance.

Medicaid: COVID-19 Telemedicine FAQs: Behavioral Health Division

STATUS: Active

Last updated 08/03/2022

Service Expansion

Medicaid: COVID-19 and Telemedicine

STATUS: Active, various expiration dates. See page for further guidance.

Medicaid: Targeted Case Management Bulletin

STATUS: Expired

Medicaid: Early Intensive Developmental and Behavioral Intervention (EIDBI)

STATUS: Expired

Medicaid: Remote Support for Home and community based services waiver

STATUS: Expired

Medicaid: COVID-19 Telemedicine FAQs: Behavioral Health Division

STATUS: Active

Medicaid: Store-and-forward telemedicine IEP services

STATUS: Active, this policy change will continue. See the Telemedicine Services section of IEP in the MHCP Provider Manual.

Minnesota Department of Human Services: Alternative adult day service delivery due to COVID-19 pandemic

STATUS: Expired

HF 33 (2021 Session): Extends COVID-19 Telehealth Waivers

STATUS: Enacted (Audio-only allowance expires June 30, 2023)

Last updated 08/03/2022

Definitions

“Telehealth” means the delivery of health care services or consultations through the use of real time two-way interactive audio and visual communications to provide or support health care delivery and facilitate the assessment, diagnosis, consultation, treatment, education, and care management of a patient’s health care. Telehealth includes the application of secure video conferencing, store-and-forward technology, and synchronous interactions between a patient located at an originating site and a health care provider located at a distant site.

Until July 1, 2023, telehealth also includes audio-only communication between a health care provider and a patient. Telehealth does not include communication between health care providers that consists solely of a telephone conversation, e-mail, or facsimile transmission. Telehealth does not include communication between a health care provider and a patient that consists solely of an e-mail or facsimile transmission. Telehealth does not include telemonitoring services.

“Telemonitoring services” means the remote monitoring of clinical data related to the enrollee’s vital signs or biometric data by a monitoring device or equipment that transmits the data electronically to a health care provider for analysis. Telemonitoring is intended to collect an enrollee’s health-related data for the purpose of assisting a health care provider in assessing and monitoring the enrollee’s medical condition or status.

SOURCE: MN Statute Sec. 62A.673(h)., (Accessed Aug. 2022).

Last updated 08/03/2022

Parity

SERVICE PARITY

A health carrier must not restrict or deny coverage of a health care service that is covered under a health plan solely because the health care service provided by the health care provider through telehealth is not provided through in-person contact; or based on the communication technology or application used to deliver the health care service through telehealth, provided the technology or application complies with this section and is appropriate for the particular service.

SOURCE: MN Statute Sec. 62A.673. (Accessed Aug. 2022).


PAYMENT PARITY

A health carrier must reimburse the health care provider for services delivered through telehealth on the same basis and at the same rate as the health carrier would apply to those services if the services had been delivered by the health care provider through in-person contact.

A health carrier must not deny or limit reimbursement based solely on a health care provider delivering the service or consultation through telehealth instead of through in-person contact. A health carrier must not deny or limit reimbursement based solely on the technology and equipment used by the health care provider to deliver the health care service or consultation through telehealth, provided the technology and equipment used by the provider meets the requirements of this section and is appropriate for the particular service.

Nothing in this subdivision prohibits a health carrier and health care provider from entering into a contract that includes a value-based reimbursement arrangement for the delivery of covered services that may include services delivered through telehealth, and such an arrangement shall not be considered a violation of this subdivision.

SOURCE: MN Statute Sec. 62A.673. (Accessed Aug. 2022).

Last updated 08/03/2022

Requirements

New Law In Effect

A health plan sold, issued, or renewed by a health carrier in Minnesota must cover benefits delivered through telehealth in the same manner as any other benefits covered under the health plan. Coverage for services delivered through telehealth must not be limited on the basis of geography, location, or distance for travel subject to the health care provider network available to the enrollee through the enrollee’s health plan.

A health carrier must not create a separate provider network to deliver services through telehealth that does not include network providers who provide in-person care to patients for the same service or require an enrollee to use a specific provider within the network to receive services through telehealth.

A health carrier may require a deductible, co-payment, or coinsurance payment for a health care service provided through telehealth, provided that the deductible, co-payment, or coinsurance payment is not in addition to, and does not exceed, the deductible, co-payment, or coinsurance applicable for the same service provided through in-person contact.

Nothing in this section requires a health carrier to provide coverage for services that are not medically necessary or are not covered under the enrollee’s health plan; or prohibits a health carrier from:

  • establishing criteria that a health care provider must meet to demonstrate the safety or efficacy of delivering a particular service through telehealth for which the health carrier does not already reimburse other health care providers for delivering the service through telehealth;
  • establishing reasonable medical management techniques, provided the criteria or techniques are not unduly burdensome or unreasonable for the particular service; or
  • requiring documentation or billing practices designed to protect the health carrier or patient from fraudulent claims, provided the practices are not unduly burdensome or unreasonable for the particular service.

Nothing requires the use of telehealth when a health care provider determines that the delivery of a health care service through telehealth is not appropriate or when an enrollee chooses not to receive a health care service through telehealth.

Prior authorization may be required for health care services delivered through telehealth only if prior authorization is required before the delivery of the same service through in-person contact. A health carrier may require a utilization review for services delivered through telehealth, provided the utilization review is conducted in the same manner and uses the same clinical review criteria as a utilization review for the same services delivered through in-person contact.

A health carrier or health care provider shall not require an enrollee to pay a fee to download a specific communication technology or application.

Telehealth Equipment

A health carrier must not require a health care provider to use specific telecommunications technology and equipment as a condition of coverage under this section, provided the health care provider uses telecommunications technology and equipment that complies with current industry interoperable standards and complies with standards required under the federal Health Insurance Portability and Accountability Act of 1996, Public Law 104-191, and regulations promulgated under that Act, unless authorized under this section.

Audio-Only – Expires July 1, 2023

A health carrier must provide coverage for health care services delivered through telehealth by means of the use of audio-only communication if the communication is a scheduled appointment and the standard of care for that particular service can be met through the use of audio-only communication. Substance use disorder treatment services and mental health care services delivered through telehealth by means of audio-only communication may be covered without a scheduled appointment if the communication was initiated by the enrollee while in an emergency or crisis situation and a scheduled appointment was not possible due to the need of an immediate response. This paragraph expires July 1, 2023.

Telemonitoring Services

A health carrier must provide coverage for telemonitoring services if:

  • the telemonitoring service is medically appropriate based on the enrollee’s medical condition or status;
  • the enrollee is cognitively and physically capable of operating the monitoring device or equipment, or the enrollee has a caregiver who is willing and able to assist with the monitoring device or equipment; and
  • the enrollee resides in a setting that is suitable for telemonitoring and not in a setting that has health care staff on site.

Exception

This section does not apply to coverage provided to state public health care program enrollees under chapter 256B or 256L.

SOURCE: MN Statute Sec. 62A.673. (Accessed Aug. 2022).

Last updated 08/02/2022

Definitions

“Telehealth” means the delivery of health care services or consultations through the use of real time two-way interactive audio and visual communication to provide or support health care delivery and facilitate the assessment, diagnosis, consultation, treatment, education, and care management of a patient’s health care. Telehealth includes the application of secure video conferencing, store-and-forward technology, and synchronous interactions between a patient located at an originating site and a health care provider located at a distant site. Telehealth does not include communication between health care providers, or between a health care provider and a patient that consists solely of an audio-only communication, e-mail, or facsimile transmission or specified by law.

SOURCE:  MN Statute 256B.0625.Subdivision 3b(I). MN Statute 256.0625(f)(1) (Definition does not include the July 1, 2023 audio-only exception). (Accessed Aug. 2022).

“Telehealth” is defined as the delivery of health care services or consultations through the use of real time, two-way interactive audio and visual communications. The purpose of telehealth is to provide or support health care delivery and facilitate the assessment, diagnosis, consultation, treatment education, and care management of a patient’s health care while the patient is at an originating site and the licensed health care provider is at a distant site.

SOURCE: MN Dept. of Human Services, Provider Manual, Physician and Professional Services (Telehealth), As revised Jul. 25, 2022 & Telehealth Services, As revised Jun. 14, 2022. (Accessed Aug. 2022).

Telehealth includes:

  • Secure video conferencing
  • Store-and-forward technology
  • Audio-only communication between the health care provider and the patient (until July 1, 2023)

SOURCE: MN Dept. of Human Services, Provider Manual, Telehealth Services, As revised Jun. 14, 2022. (Accessed Aug. 2022).

“Telehealth” means the practice of medicine as defined in Minnesota Statutes, section 147.081, subdivision 3, when the health care practitioner is not in the physical presence of the patient.

SOURCE: MN Admin Rules 4770.4002 Subp. 23. (Accessed Aug. 2022).

Chemical Dependency Treatment

“Telehealth” means the delivery of a substance use disorder treatment service while the client is at an originating site and the health care provider is at a distant site via telehealth as defined in section 256B.0625, subdivision 3b, and as specified in section 254B.05, subdivision 5, paragraph (f).

SOURCE: MN Statute Sec. 245G.01 Subd. 26. (Accessed Aug. 2022).

Home Health Agency

“Telehomecare” means the use of telecommunications technology via live, two-way interactive audiovisual technology which may be augmented by store-and-forward technology.

SOURCE: MN Statute Sec. 256B.0653(l). (Accessed Aug. 2022).

Telehealth Services

Telehealth is the delivery of health care services or consultations through the use of real time, two-way interactive audio and visual communications. Telehealth provides or supports health care delivery and facilitates the assessment, diagnosis, consultation, treatment education and care management of a patient’s health care while the patient is at originating site and the licensed health care provider is at a distant site. Providers providing health care services by telehealth will be held to the same standards and conduct as providers for in-person health care services.

SOURCE: MN Department of Human Services, Telehealth Services,  Jun. 14, 2022. (Accessed Aug. 2022). 

Teledentistry Services

Teledentistry is the delivery of dental care services or consultations while the patient is at an originating site and the dentist is at a distant site.

SOURCE: MN Department of Human Services, Teledentistry Services, Revised Mar. 14, 2022. (Accessed Aug. 2022). 

Telehealth Delivery of Mental Health Services

Telehealth is the delivery of health care services or consultations through the use of real time, two-way interactive audio and visual communications. Telehealth provides or supports health care delivery and facilitates the assessment, diagnosis, consultation, treatment, education, and care management of a patient’s health care while the patient is at originating site and the licensed health care professional is at a distant site. Telehealth includes the application of secure video conferencing, store-and-forward technology, and synchronous interactions between a patient located at an originating site and a health care provider located at a distant site.

SOURCE: MN Dept. of Human Services, Provider Manual, Telemedicine Delivery of Mental Health Services, Revised Jun. 24, 2022, (Accessed Aug. 2022).

 

Last updated 08/01/2022

Email, Phone & Fax

Telehealth does not include communication between health care providers, or between a health care provider and a patient that consists solely of an audio-only communication, e-mail, or facsimile transmission or as specified by law.

SOURCE: MN Statute Sec. 256B.0625, Subsection 3(b)(f)(1). (Accessed Aug. 2022).

Case management for Child Welfare Transitional Case Management services is covered through telephone in certain circumstances.

SOURCE: MN Dept. of Human Svcs., Provider Manual, Child Welfare Case Management Services, As revised Jun. 14, 2022. (Accessed Aug. 2022).

Audio only (until July 1, 2023)

Audio only is the delivery of health care services or consultations through telephone communication while the patient is at one site and the qualified health care provider is at a distant site.

Audio-only communication will be covered if:

  • There is a scheduled appointment and the standard of care for that particular service can be met through the use of audio-only communication.
  • Substance use disorder (SUD) treatment services and mental health services delivered without a scheduled appointment when initiated by the member while in an emergency or crisis situation and a scheduled appointment was not possible due to the need of an immediate response.

Telehealth does not include:

  • Communication between health care provider and a patient that consists solely of an email or facsimile.
  • Electronic connections that are not conducted over a secure encrypted website as specified by the Health Insurance Portability and Accountability Act of 1996 Privacy and Security rules

Providers who have an approved Telehealth Provider Assurance Statement (DHS-6806) (PDF) on file with MHCP who submit professional claims for services via telehealth should use claim format 837P (professional), CPT or HCPCS codes that describes the services rendered and with a required place of service 02 or new place of service 10 for services via telehealth. Include the 93 modifier when billing for services provided via audio only (telephone communication).

Modifier 93 Audio only: Synchronous telehealth service rendered via telephone or other real-time interactive audio-only telecommunications system. MHCP requires modifier 93 when audio-only telehealth is used.

Outpatient facilities (APC or ASC claims) will continue to use telehealth modifiers on their claims.

Providers who service SUD H2035/HQ on type of bill 89X should continue to use telehealth modifiers on their claims.

SOURCE: MN Dept. of Human Services, Telehealth Services Provider Manual, Jun. 14, 2022. (Accessed Aug. 2022).

New Telehealth Modifier and Use of Current Telehealth Modifiers

Modifier 93, Audio only: Synchronous telehealth service rendered via telephone or other real-time interactive audio-only telecommunications system. MHCP requires this modifier when audio-only telehealth is used.

SOURCE: MN Dept. of Human Svcs., Provider Manual, Telehealth Delivery of Mental Health Services, Revised Jun. 2022 (Accessed Aug. 2022).

Last updated 08/02/2022

Live Video

POLICY

Medical assistance covers medically necessary services and consultations delivered by a health care provider through telehealth in the same manner as if the service was delivered through in-person contact.  Services or consultations delivered through telehealth are paid at the full allowable rate.

SOURCE: MN Statute Sec. 256B.0625, Subdivision 3b(a). (Accessed Aug. 2022).

MHCP programs will cover telehealth services in the same manner as any other benefits covered through the programs. Coverage will not be limited on the basis of geography or location. Out-of-state coverage policy applies to services provided via telehealth.

SOURCE: MN Dept. of Human Services, Provider Manual, Telehealth Services, As revised Jun. 14, 2022. (Accessed Aug. 2022).

Minnesota’s Medical Assistance program reimburses live video for fee-for-service programs.

Providers must self-attest that they meet all of the conditions of the MHCP telehealth policy by completing and submitting the Telehealth Provider Assurance Statement (DHS-6806) (PDF) to be eligible for reimbursement.

SOURCE: MN Dept. of Human Services, Provider Manual, Physician and Professional Services (Telehealth), As revised Jul. 25, 2022. (Accessed Aug. 2022).


ELIGIBLE SERVICES/SPECIALTIES

MHCP programs will cover telehealth services in the same manner as any other benefits covered through the programs. Coverage will not be limited on the basis of geography or location. Out-of-state coverage policy applies to services provided via telehealth.

SOURCE: MN Dept. of Human Services, Provider Manual, Telehealth Services, As revised Jun. 14, 2022. (Accessed Aug. 2022).

The CPT and HCPC codes that describe a telehealth service are generally the same codes that describe an encounter when the health care provider and patient are at the same site. Examples of eligible services:

  • Consultations
  • Telehealth consults: emergency department or initial inpatient care
  • Subsequent hospital care services with the limitation of one telehealt visit every 30 days per eligible provider
  • Subsequent nursing facility care services with the limitation of one telehealth visit every 30 days
  • End-stage renal disease services
  • Individual and group medical nutrition therapy
  • Individual and group diabetes self-management training with a minimum of one hour of in-person instruction to be furnished in the initial year training period to ensure effective injection training
  • Smoking cessation
  • Alcohol and substance abuse (other than tobacco) structured assessment and intervention services

SOURCE: MN Dept. of Human Services, Provider Manual, Physician and Professional Services (Telehealth), As revised Jul. 25, 2022 & Telehealth Services, As revised Jun. 14, 2022. (Accessed Aug. 2022).

Telehealth does not include:

  • Communication between health care provider and a patient that consists solely of an email or facsimile.
  • Electronic connections that are not conducted over a secure encrypted website as specified by the Health Insurance Portability and Accountability Act of 1996 Privacy and Security rules
  • Prescription renewal
  • Scheduling a test or appointment
  • Clarification of issues from a previous visit
  • Reporting test results
  • Nonclinical communication

SOURCE: MN Dept. of Human Services, Provider Manual, Telehealth Services, As revised Jun. 14, 2022. (Accessed Aug. 2022).

Non-covered services:

SOURCE: MN Dept. of Human Services, Provider Manual, Physician and Professional Services (Telehealth), As revised Jul. 25, 2022, (Accessed Aug. 2022).

Two-way interactive video consultation in an emergency department (ED)

Two-way interactive video consultation may be billed when no physician is in the ED and the nursing staff is caring for the patient at the originating site. The ED physician at the distant site bills the ED CPT codes with place of service 02. Nursing services at the originating site would be included in the ED facility code. If the ED physician requests the opinion or advice of a specialty physician at a “hub” site, the ED physician bills the ED CPT codes and the consulting physician bills the consultation E/M code with place of service 02.

SOURCE: MN Dept of Human Services, Telehealth Services Manual, Jun. 14, 2022. (Accessed Aug. 2022).

Mental Health Services

Subject to federal approval, mental health services that are otherwise covered by medical assistance as direct face-to-face services may be provided via telehealth in accordance with subdivision 3b.

SOURCE: MN Statute Sec. 256B.0625, Subd. 46. (Accessed Aug. 2022).

MHCP members eligible for mental health services can receive mental health services delivered through telehealth.

Mental health services covered by medical assistance as direct face-to-face services may be provided via telehealth and are covered by MHCP. For mental health services or assessments delivered through telehealth that are based on an individual treatment plan, the provider may document the client’s verbal approval or electronic written approval of the treatment plan or change in the treatment plan in lieu of the client’s signature.

Authorization is required for mental health services delivered through telehealth if authorization is required for the same service through in-person contact.

SOURCE: MN Dept. of Human Services, Provider Manual, Telehealth Delivery of Mental Health Services, Revised Jun. 24, 2022, (Accessed Aug. 2022).

Assertive Community Treatment and Intensive Residential Treatment Services

Physician services that are not separately billed may be included in the rate to the extent that a psychiatrist, or other health care professional providing physician services within their scope of practice, is a member of the intensive residential treatment services treatment team. Physician services, whether billed separately or included in the rate, may be delivered by telehealth.

SOURCE:  MN Statute Sec 256B.0622, subdivision 8(e), (Accessed Aug. 2022).

Individualized Education Program (IEP)

Telehealth coverage applies to a child or youth who is MA eligible, has an IEP and the service provided is identified in the IEP. Whether the originating site is a home or school must be documented in the child’s health record.  Limited to three visits per week per child or youth.

To be eligible for reimbursement, the school or school district must self-attest that the telehealth services provided by the professional provider either employed by or contracted by the school meet all of the conditions of the MHCP telehealth policy by completing the Provider Assurance Statement for Telehealth (DHS-6806) (PDF).

Non-Covered Services:

  • Evaluation or assessments that are less effective than if provided in-person, face-to-face
  • Supervision evaluations or visits
  • Personal care assistants
  • Nursing services
  • Transportation services
  • Electronic connections that are conducted over a website that is not secure and encrypted as specified by the Health Insurance Portability & Accountability Act of 1996 Privacy & Security rules (for example, Skype)
  • Prescription renewals
  • Scheduling a test or appointment
  • Clarification of issues from a previous visit
  • Reporting test results
  • Non-clinical communication
  • Communication via telephone, email or fax

Use the same HCPC codes and modifiers that describe the IEP services being performed via telehealth as you would if the service was being provided in person with the child at the same site.

Use 02 place of service code. See IEP manual for specific documentation and billing requirements.

SOURCE: MN Dept. of Human Svcs., Provider Manual, IEP Services, Revised May 19, 2022, (Accessed Aug. 2022).

The following medically necessary substance use disorder (SUD) services provided by eligible SUD providers via telehealth are covered:

  • Comprehensive assessments
  • Individual and group treatment services
  • Peer recovery support services

See the Telehealth Services section of the MHCP Provider Manual for noncovered telehealth services.

SOURCE: Substance Use Disorder Telehealth, Jun. 27, 2022, (Accessed Aug. 2022).

Dental

MHCP allows payment for teledentistry services.  Reimbursement for teledentistry is the same as face-to-face encounters. See list of codes, documentation and billing requirements in provider manual.  A provider must self-attest to meet all the conditions of the MHCP telehealth policy by completing the Provider Assurance Statement for telehealth.

Covered Services (See manual for exact CDT codes):

  • Periodic oral evaluation (with an established patient)
  • Limited oral exam
  • Oral evaluation for a patient under 3 years of age
  • Comprehensive oral evaluation (new or established patient)
  • Intraoral (complete series of radiographic images)
  • Intraoral (periapical first radiographic image)
  • Intraoral (periapical each additional radiographic image)
  • Bitewing (single radiographic image)
  • Bitewings (two radiographic images)
  • Bitewings (four radiographic images)
  • Intraoral—occlusal radiographic image
  • Panoramic radiographic imaging
  • Medical dental consultation

Limitations

  • MHCP will pay for only one reading or interpretation of diagnostic tests such as X-rays, lab tests and diagnostic assessment.
  • Payment is not available to providers for sending materials.
  • Out-of-state coverage policy applies to services provided via teledentistry services
  • Consultations performed by providers who are not located in Minnesota and contiguous counties require authorization prior to the service being provided.

SOURCE (Dental): MN Dept. of Human Svcs., Provider Manual, Dental Svcs. Mar. 14, 2022 (Accessed Aug. 2022).

Early Intensive Developmental and Behavioral Intervention (EIDBI) services

Telehealth is an option for Early Intensive Developmental and Behavioral Intervention (EIDBI) services. Use 02 place of service code.

Eligible services include:

  • Comprehensive multi-disciplinary evaluation
  • Coordinated care conference
  • Family/caregiver training and counseling
  • Individual treatment plan (ITP) development and progress monitoring
  • Intervention- group or individual only (higher intensity intervention sessions cannot occur via telehealth)
  • Observation and direction

EIDBI Benefits grid also lists adaptive behavioral treatment by protocol and group adaptive behavior treatment by protocol.   See grid for more information.

SOURCE: MN Dept. of Human Svcs., EIDBI Services Benefits billing grid, Jun. 2022 (Accessed Jun. 2022) & MN Dept. of Human Services, EIDBI Benefit Policy Manual, EIDBI Telehealth Services.  Mar. 16, 2022. (Accessed Aug. 2022).

Medical assistance covers medically necessary EIDBI services and consultations delivered by a licensed health care provider via telehealth, in the same manner as if the service or consultation was delivered in person.

SOURCE: MN Statute Sec. 256B.0949, Subdivision. 13. (Accessed Aug. 2022).

Rehabilitation Services

MHCP allows payment for some rehabilitation services through telehealth. Physical and occupational therapists, speech-language pathologists and audiologists may use telehealth to deliver certain covered rehabilitation therapy services that they can appropriately deliver via telehealth. Service delivered by this method must meet all other rehabilitation therapy service requirements and providers must adhere to the same standards and ethics as they would if the service was provided face to face. Must use GT or GQ modifiers.  Providers must self-attest that they meet all of the conditions of MHCP telehealth policy by completing the “Provider Assurance Statement for Telehealth”.   When submitting claims for telehealth services, use place-of-service code 02 to certify that the services meets the telehealth requirements. The GQ modifier is required when billing for services via asynchronous telecommunication systems.

Limited to three sessions per week per member.  Payment not available for sending materials to a recipient, other providers or other facilities. Payment is made only for one reading or interpretation of diagnostic tests such as x-rays, lab tests, and diagnostic assessments.

Noncovered services:

  • Electronic connections that are not conducted over a secure encrypted website as specified by HIPAA
  • Scheduling a test or appointment
  • Clarification of issues from a previous visit
  • Reporting test results
  • Non-clinical communication
  • Communication via telephone, email or fax

SOURCE: MN Dept. of Human Svcs., Provider Manual, Rehabilitation Svcs. Jan. 25, 2022 (Accessed Aug. 2022).

Medication Therapy Management Services (MTMS)

Under certain circumstances MTMS can be delivered via interactive video.  See section on “eligible sites” for more information.  To be eligible providers must submit a provider assurance statement, use equipment compliant with HIPAA (see manual for details) and use the GT modifier and 02 POS code.

Noncovered services:

  • Encounters in the inpatient setting
  • Encounters in skilled nursing facilities
  • Encounters for MTMS for dual-eligible members

MTMS services delivered by telehealth must meet all state and federal requirements for equipment, privacy and billing, including the following:

  • Telehealth systems must be compliant with HIPAA privacy and security requirements and regulations.
  • Billing providers must submit claims with the applicable MTMS codes and telehealth (telemedicine) identifiers to signify that the service was delivered by telehealth. Billing requirements for telehealth (telemedicine) services are described in the Physician and Professional Services section of the MHCP Provider Manual.
  • Providers must submit the Telehealth Provider Assurance Statement (DHS-6806) (PDF) before billing for telehealth MTMS encounters.

SOURCE: MN Dept. of Human Svcs., Provider Manual, Medication Therapy Management Svcs. Nov. 3, 2021 (Accessed Aug. 2022).

Behavioral Health Home Services

If an individual accepts the offer for a face-to-face visit at six months, providers who are eligible to provide services via telemedicine may do so. Providers must have a valid telemedicine agreement in place with DHS and must comply with all MA telemedicine requirements for equipment, privacy and billing to serve individuals receiving BHH services through telemedicine. Refer to the following sections for requirements, billing and additional information:

SOURCE: MN Department of Human Services, Behavioral Health Home Services, Feb. 23, 2022. (Accessed Aug. 2022).

Targeted Case Management

For adult MH-TCM, interactive video may be used instead of a face-to-face contact if the client resides in a hospital, nursing facility, residential mental health facility or an intermediate care facility for persons with developmental disabilities. The use of interactive video may substitute for no more than 50 percent of the required face-to-face contacts.

SOURCE: MN Dept. of Human Services, Adult Mental Health Targeted Case Management and Children’s Mental Health Targeted Case Management, Jun. 14. 2022 (Accessed Aug. 2022).

Commissioner of Human Services; Extension of Covid-19 Human Services Program Modifications

Notwithstanding Laws 2020, First Special Session chapter 7, section 1, subdivision 2, as amended by Laws 2020, Third Special Session chapter 1, section 3, when the peacetime emergency declared by the governor in response to the COVID-19 outbreak expires, is terminated, or is rescinded by the proper authority, the following modifications issued by the commissioner of human services pursuant to Executive Orders 20-11 and 20-12, and including any amendments to the modification issued before the peacetime emergency expires, shall remain in effect until July 1, 2023:

(1) CV16: expanding access to telemedicine services for Children’s Health Insurance Program, Medical Assistance, and MinnesotaCare enrollees; and

(2) CV21: allowing telemedicine alternative for school-linked mental health services and intermediate school district mental health services.

SOURCE: MN Session Laws, 2021, 1st Special Session, Ch. 7, H.F. No. 33. (Accessed Aug. 2022).


ELIGIBLE PROVIDERS

Distant site

Site at which the health care provider is located while providing health care services or consultations by means of telehealth, which can include the provider’s home.

MHCP covers medically necessary services and consultations delivered by a health care provider through telehealth. A health care provider means a health care professional who is licensed or registered by the state to perform health care services within the provider’s scope of practice according to state law. A provider must self-attest that they meet all the conditions of the MHCP telehealth policy by completing and submitting the Telehealth Provider Assurance Statement to be eligible for reimbursement.

SOURCE: MN Dept. of Human Services, Telehealth Services Manual, Jun. 14, 2022. (Accessed Aug. 2022). 

Providers must self-attest that they meet all of the conditions of the MHCP telehealth policy by completing and submitting the Telehealth Provider Assurance Statement (DHS-6806) (PDF) to be eligible for reimbursement. The following provider types are eligible to provide telehealth services:

  • Physician
  • Nurse practitioner
  • Physician assistant
  • Nurse midwife
  • Clinical nurse specialist
  • Registered dietitian or nutrition professional
  • Dentist, dental hygienist, dental therapist, advanced dental therapist
  • Mental health professional, when following the requirements and service limitations listed in the Telehealth Delivery of Mental Health Services section.
  • Pharmacist
  • Certified genetic counselor
  • Podiatrist
  • Speech therapist
  • Physical therapist
  • Occupational therapist
  • Audiologist

SOURCE: MN Dept. of Human Services, Provider Manual, Physician and Professional Services (Telehealth), As revised Jul. 25, 2022, (Accessed Aug. 2022).

Medical assistance covers medically necessary services and consultations delivered by a licensed health care provider via telehealth, health care provider means a health care provider as defined under section 62A.673, a community paramedic as defined under section 144E.001, subdivision 5f, a community health worker who meets the criteria under subdivision 49, paragraph (a), a mental health certified peer specialist under section 256B.0615, subdivision 5, a mental health certified family peer specialist under section 256B.0616, subdivision 5, a mental health rehabilitation worker under section 256B.0623, subdivision 5, paragraph (a), clause (4), and paragraph (b), a mental health behavioral aide under section 256B.0943, subdivision 7, paragraph (b), clause (3), a treatment coordinator under section 245G.11, subdivision 7, an alcohol and drug counselor under section 245G.11, subdivision 5, a recovery peer under section 245G.11, subdivision 8.

Telehealth visits may be used to satisfy the face-to-face requirement for reimbursement under the payment methods that apply to a federally qualified health center, rural health clinic, Indian health service, 638 tribal clinic, and certified community behavioral health clinic, if the service would have otherwise qualified for payment if performed in person.

SOURCE: MN Statute Sec. 256B.0625, Subd. 3b(d) & (f)(2). (Accessed Aug. 2022).

Individualized Education Program (IEP)

Use place of service 02 on claims to indicate when the child receives the health-related service via telecommunication technology when the child is in a location other than a child’s home.

Eligible providers include the following:

  • Charter schools
  • Education districts
  • Intermediate districts
  • Public school districts
  • Tribal schools (schools that receive funding from the Bureau of Indian Affairs-BIA)
  • Service cooperatives
  • Special education cooperatives
  • State academies

SOURCE: MN Dept. of Human Svcs., Provider Manual, IEP Services, Revised May 19, 2022. (Accessed Aug. 2022).

Early Intensive Developmental and Behavioral Intervention (EIDBI) services

Eligible providers include health care professionals who are licensed or registered by the state to perform health care services within the provider’s scope of practice and in accordance with state law.

Eligible providers are defined as:

  • Mental health professionals (as defined under Minn. Stat. §245.462, subd. 18 or Minn. Stat. §245.4871, subd. 27)
  • Mental health practitioners (as defined by Minn. Stat. §245.462, subd. 17 or Minn. Stat. §245.4871, subd. 26) working under the general supervision of a mental health professional.

A comprehensive multi-disciplinary evaluation provider, qualified supervising professional, (Level I or Level II) EIDBI provider may apply to provide EIDBI services via telehealth.

SOURCE: MN Dept. of Human Services, EIDBI Benefit Policy Manual, EIDBI Telehealth Services.  Mar. 16, 2022.  (Accessed Aug. 2022).

Mental Health Services

Eligible providers include any of the following:

  • Mental health professionals who are qualified under Minnesota Statute 245.462, subdivision 18
  • Mental health practitioners working under the supervision of a mental health professional
  • Mental health certified peer specialists
  • Mental health certified family peer specialists
  • Mental health rehabilitation workers
  • Mental health behavioral aides

Providers must self-attest that they meet all of the conditions of the MHCP telehealth policy by completing and submitting a Telehealth Provider Assurance Statement (DHS-6806) (PDF) to be eligible to provide and be reimbursed for services provided via telehealth.

SOURCE: MN Dept. of Human Svcs., Provider Manual, Telehealth Delivery of Mental Health Services, Revised Jun. 24, 2022 (Accessed Aug. 2022).

Providers currently authorized to provide services may conduct the same services via telehealth. Providers must self-attest that they meet all of the conditions of the MHCP telehealth policy by completing and submitting the Telehealth Provider Assurance Statement (DHS-6806) (PDF) to be eligible to provide and be reimbursed for services via telehealth.

SOURCE: MN Dept. of Human Svcs., Provider Manual, Substance Use Disorder Telehealth, Jun. 27, 2022 (Accessed Aug. 2022).

Rehabilitation Services

Eligible providers:

  • Speech-language pathologists
  • Physical therapists
  • Physical therapist assistants
  • Occupational therapists
  • Occupational therapy assistants
  • Audiologists

Physical therapist assistants and occupational therapy assistants providing services via telehealth must follow the same supervision policy as indicated in “Rehabilitation Service Practitioners”. The distant site is the location of the health care provider at the time the provider is delivering the service to an eligible MHCP member via telecommunication system. There are no specific authorized distant sites or restrictions, but providers must ensure a secure transmission that meets Health Insurance Portability & Accountability Act of 1996 Privacy and Security (HIPAA) requirements. Providers must self-attest that they meet all of the conditions of the MHCP telehealth policy by completing the Provider Assurance Statement for Telehealth (DHS-6806) (PDF). See manual for documentation requirements. When submitting claims for telemedicine services, use place-of-service code 02 to certify that the services meets the telemedicine requirements. The GQ modifier is required when billing for services via asynchronous telecommunication systems (via computer).

SOURCE: MN Dept. of Human Svcs., Provider Manual, Rehabilitation Svcs. Jan. 25, 2022. (Accessed Aug. 2022).

Dental

Eligible providers

  • Dentist
  • Advanced dental therapists
  • Dental therapists
  • Dental hygienists
  • Licensed dental assistants
  • Other licensed health care professionals

SOURCE: MN Dept. of Human Svcs., Provider Manual, Dental Svcs. Mar. 14, 2022. (Accessed Aug. 2022).

Medical Assistance Services and Payment Rates

Effective July 1, 2022, telehealth visits provided through audio and real time video communication may be used to satisfy the face-to-face requirement for reimbursement under the payment methods that apply to federally qualified health centers, rural health centers, Indian Health Service and 638 Tribal clinics, and certified community behavioral health centers. This change extends the current telehealth reimbursement policy for these provider types beyond the federal public health emergency. This change is not expected to have a fiscal impact. Laws of Minnesota 2021, First Special Session, chapter 7, article 6, section 11.

SOURCE: MN Statute 256B.0625. (Accessed Aug. 2022).


ELIGIBLE SITES

The site at which the member is located at the time health care services are provided to them by means of telehealth, which can include the member’s home.

Providers who have an approved Telehealth Provider Assurance Statement (DHS-6806) (PDF) on file with MHCP who submit professional claims for services via telehealth should use claim format 837P (professional), CPT or HCPCS codes that describes the services rendered and with a required place of service 02 or new place of service 10 for services via telehealth. Include the 93 modifier when billing for services provided via audio only (telephone communication).

  • Place of service 02 newly defined: Telehealth provided other than the patient’s home. The location where health services and health-related services are provided or received through telecommunication technology. The patient is not located in their home when receiving health services or health-related services through telecommunication technology.
  • Place of service 10: Telehealth provided in patient’s home. The location where health services and health-related services are provided or received through telecommunication technology. The patient is located in their home (which is a location other than a hospital or other facility where the patient receives care in a private residence) when receiving health services or health-related services through telecommunication technology.
  • Modifier 93 Audio only: Synchronous telehealth service rendered via telephone or other real-time interactive audio-only telecommunications system. MHCP requires modifier 93 when audio-only telehealth is used.

Outpatient facilities (Ambulatory Payment Classifications or Ambulatory Surgical Center claims) will continue to use telehealth modifiers on their claims.

Providers who service SUD H2035/HQ on type of bill 89X should continue to use telehealth modifiers on their claims.

SOURCE: MN Dept. of Human Services, Telehealth Services Manual, Jun. 14, 2022. (Accessed Aug. 2022). 

Physician and Professional Services

Providers should have a Telehealth Provider Assurance Statement (DHS-6806) (PDF) on their provider file beginning June 1, 2022, to bill claims for services provided via telehealth. Providers who submit professional claims for services via telehealth should use claim format 837P (professional), including the CPT or HCPCS code that describes the services rendered and the place of service 02 or new place of service 10 for services via telehealth. Include the 93 modifier when billing for services provided via audio only (telephone communication).

Place of service 02 (newly redefined): Telehealth provided other than the patient’s home. It’s the location where health services and health-related services are provided or received through telecommunication technology. The patient is not located in their home when receiving health services or health-related service through telecommunication technology.

Place of service 10 (new place of service): Telehealth provided in patient’s home. The location where health services and health-related services are provided or received through telecommunication technology. Patient is located in their home (which is a location other than a hospital or other facility where the patient receives care in a private residence) when receiving health services or health-related services through telecommunication technology.

When reporting a service with place of service 02 or 10, you are certifying that you are rendering services to a patient located in an eligible originating site via an interactive audio and visual telecommunications system.

Modifier 93, Audio only: Synchronous telehealth service rendered via telephone or other real-time interactive audio-only telecommunications system. MHCP requires this modifier when audio-only telehealth is used.

All other telehealth modifiers: All the other telehealth modifiers (GT, GQ, GO, 95) can be used for informational purposes but will not be required. The telehealth place of service codes explain that the service is rendered through telehealth. No telehealth modifiers can be used without place of service 02 or 10 or the claim will deny.

SOURCE: MN Dept. of Human Services, Provider Manual, Physician and Professional Services (Telehealth), As revised Jul. 25, 2022, (Accessed Aug. 2022).

Mental Health Delivery

Providers should have a Telehealth Provider Assurance Statement (DHS-6806) (PDF) on their provider file beginning June 1, 2022, to bill claims for services provided via telehealth. Providers must have documentation of services provided and must have followed all clinical standards to bill for telehealth.

Place of service 02 (newly redefined): Telehealth provided other than the patient’s home. It’s the location where health services and health-related services are provided or received through telecommunication technology. The patient is not located in their home when receiving health services or health-related service through telecommunication technology.

Place of service 10 (new place of service): Telehealth provided in patient’s home. The location where health services and health-related services are provided or received through telecommunication technology. Patient is located in their home (which is a location other than a hospital or other facility where the patient receives care in a private residence) when receiving health services or health-related services through telecommunication technology.

When reporting a service with place of service 02 or 10, you are certifying that you are rendering services to a patient located in an eligible originating site via an interactive audio and visual telecommunications system.

Modifier 93, Audio only:Synchronous telehealth service rendered via telephone or other real-time interactive audio-only telecommunications system. MHCP requires this modifier when audio-only telehealth is used.

SOURCE: MN Dept. of Human Svcs., Provider Manual, Telehealth Delivery of Mental Health Services, Revised Jun. 24, 2022 (Accessed Aug. 2022).

Individualized Education Program (IEP)

Use place of service 10 on claims to indicate when the child receives the health-related service via telecommunication technology in the child’s home. This is a location other than a hospital or other facility where the child receives care in a private residence.

Eligible originating sites, the location of the child or youth at the time the service is provided.  Document in the child’s health record:

  • Home
  • School

SOURCE: MN Dept. of Human Svcs., Provider Manual, Individualized Education Program, May 19, 2022 (Accessed Aug. 2022).

Medication Therapy Management Services (MTMS)

Medication therapy management services include the following:

  • Face-to-face or telehealth encounters done in any of the following:
    • Ambulatory care outpatient setting
    • Clinics
    • Pharmacies
    • Member’s home or place of residence if the member does not reside in a skilled nursing facility

See manual for privacy, equipment and reimbursement requirements.

SOURCE: MN Dept. of Human Svcs., Provider Manual, Medication Therapy Management Svcs. Nov. 3, 2021 (Accessed Aug. 2022).

Telehealth Delivery of Substance Use Disorder Services

MHCP allows payment for telehealth services in substance use disorder treatment for services that are otherwise covered as direct face-to-face services.

Place of service 02 (newly defined): Telehealth provided other than the patient’s home. The location where health services and health-related services are provided or received through telecommunication technology. The patient is not located in their home when receiving health services or health-related services through telecommunication technology.

SOURCE: MN Dept. of Human Svcs., Provider Manual, Substance Use Disorder Telehealth, Jun 27, 2022, (Accessed Aug. 2022).

Dental

Affiliate practice or originator within Minnesota Board of Dentistry defined scope of practice must be present at originating site.

SOURCE: MN Dept. of Human Svcs., Provider Manual, Dental Svcs. Mar. 14, 2022. (Accessed Aug. 2022).

Rehabilitation Services

Eligible originating sites:

  • Office of physician or practitioner
  • Hospital (inpatient or outpatient)
  • Critical access hospital (CAH)
  • Rural health clinic (RHC) and Federally Qualified Health Center (FQHC)
  • Hospital-based or CAH-based renal dialysis center (including satellites)
  • Skilled nursing facility (SNF)
  • End-stage renal disease (ESRD) facilities
  • Community mental health center
  • Dental clinic
  • Residential facilities, such as a group home and assisted living
  • Home (a licensed or certified health care provider may need to be present to facilitate the delivery of telehealth services provided in a private home)
  • School

SOURCE: MN Dept. of Human Svcs., Provider Manual, Rehabilitation Svcs. Jan. 25, 2022. (Accessed Aug. 2022).

Tribal Facilities

Outpatient telemedicine services provided through tribal facilities may be paid at the IHS encounter ate or applicable fee-for-service rate.  An encounter for a tribal or IHS facility means a face-to-face visit between a member eligible for MA and any health professional at or through an IHS or tribal service location for the provision of MA covered services within a 24-hour period ending at midnight.

SOURCE: MN Dept. of Human Svcs., Provider Manual, Tribal and Federal Indian Health Svcs., September 9, 2021 (Accessed Aug. 2022).


GEOGRAPHIC LIMITS

No reference found.


FACILITY/TRANSMISSION FEE

Early Intensive Developmental and Behavioral Intervention (EIDBI) services

MHCP does not reimburse for connection charges or origination, set-up or site fees.

SOURCE: MN Dept. of Human Services, EIDBI Benefit Policy Manual, EIDBI Telehealth Services. Mar. 16, 2022. (Accessed Aug. 2022).

Physician and Professional Services

MHCP does not pay an originating site facility fee. Services billed on an outpatient claim with the GQ modifier will pay zero.

SOURCE: MN Dept. of Human Services, Provider Manual, Physician and Professional Services (Telehealth), As revised Jul. 25, 2022, (Accessed Aug. 2022).

Mental Health Delivery

MHCP does not pay an originating site facility fee. Services billed on an outpatient claim with the GQ modifier will pay zero.

SOURCE: MN Dept. of Human Svcs., Provider Manual, Telehealth Delivery of Mental Health Services, Revised Jun. 24, 2022 (Accessed Aug. 2022).

Last updated 08/03/2022

Miscellaneous

Clinical Supervision of Outpatient Mental Health Services

Clinical supervision must be conducted by a qualified supervisor using individual or group (or both) supervision. Individual or group face-to-face supervision may be conducted via electronic communications that utilize interactive telecommunications equipment that includes at a minimum audio and video equipment for two-way, real-time, interactive communication between the supervisor and supervisee, and meet the equipment and connection standards of telemedicine.

SOURCE: MN Dept. of Human Services, Provider Manual, Clinical Supervision of Outpatient Mental Health Services, 8/4/2016, (Accessed Aug. 2022).  

Early Intensive Developmental and Behavioral Intervention (EIDBI) services

Services must be:

  • Compliant with HIPAA and security requirements and regulation
  • Compliant with industry interoperable standards (i.e., ability for systems and organizations to share data and information)
  • Medically appropriate to the condition and needs of the person and/or family.

SOURCE: MN Dept. of Human Services, EIDBI Benefit Policy Manual, EIDBI Telehealth Services.  Mar. 16, 2022.  (Accessed Aug. 2022).

Commissioner of Human Services: Extension of COVID-19 Human Services Program Modifications

When the peacetime emergency declared by the governor in response to the COVID-19 outbreak expires, is terminated, or is rescinded by the proper authority, the following modifications issued by the commissioner of human services pursuant to Executive Orders 20-11 and 20-12, and including any amendments to the modification issued before the peacetime emergency expires, shall remain in effect until July 1, 2023:

  1. CV16: expanding access to telemedicine services for Children’s Health Insurance Program, Medical Assistance, and MinnesotaCare enrollees; and
  2. CV21: allowing telemedicine alternative for school-linked mental health services and intermediate school district mental health services.

Study of Telehealth Expansion and Payment Parity

The commissioner of health, in consultation with the commissioners of human services and commerce, shall study the impact of telehealth expansion and payment parity under this article on the coverage and provision of health care services under public health care programs.

The study must review and make a number of recommendations relating to specified issues such as payment parity and audio-only policy impacts. A preliminary report is due by January 15, 2023 and should include whether audio-only communication should be allowed as a telehealth option beyond June 30, 2023. The commissioners shall present a final report to the chairs and ranking minority members of these specified legislative committees by January 15, 2024.

SOURCE: HF 33, Sec. 26 (2021 Session). (Accessed Aug. 2022).

Last updated 08/03/2022

Out of State Providers

Out-of-state coverage policy applies to services provided via telehealth. See out-of-state providers section of manual.

SOURCE: MN Dept. of Human Services, Provider Manual, Physician and Professional Services (Telehealth), As revised Jul. 25, 2022 (Accessed Aug. 2022) & MN Dept of Human Services, Provider Manual, Provider Basics: Out-of-State Providers.  Revised 5/19/21 (Accessed Aug. 2022).

Last updated 07/29/2022

Overview

Minnesota Medicaid provides reimbursement for live video, store-and-forward and telemonitoring through their Medical Assistance (MA) program for certain providers when patients are located at specific originating sites.  Many of their individual programs have their own unique requirements for telehealth reimbursement.  Under a new law, MA is covering audio-only through an expansion of emergency waivers until July 1, 2023.

Last updated 08/03/2022

Remote Patient Monitoring

POLICY

Telemonitoring (Remote Physiological Monitoring Services)

Medical assistance covers telemonitoring services if:

  • The telemonitoring service is medically appropriate based on the recipient’s medical condition or status;
  • The recipient’s health care provider has identified that telemonitoring services would likely prevent the recipient’s admission or readmission to a hospital, emergency room, or nursing facility;
  • The recipient is cognitively and physically capable of operating the monitoring device or equipment, or the recipient has a caregiver who is willing and able to assist with the monitoring device or equipment; and
  • The recipient resides in a setting that is suitable for telemonitoring and not in a setting that has health care staff on site.

Telemonitoring services are the remote monitoring of data related to a member’s vital signs or biometric data by a monitoring device or equipment that transmits the data electronically to a provider for analysis. The assessment and monitoring of the health data transmitted by telemonitoring must be performed by one of the following licensed health care professionals: physician, podiatrist, registered nurse, advanced practice registered nurse, physician assistant, respiratory therapist, or licensed professional working under the supervision of a medical director.

SOURCE: MN Statute Sec. 256B.0625 Subd. 3(h). (Accessed Aug. 2022).

MHCP covers telemonitoring services for MHCP members in fee-for-service programs.

Telemonitoring services are the remote monitoring of data related to a member’s vital signs or biometric data by a monitoring device or equipment that transmits the data electronically to a provider for analysis. Telemonitoring is a tool that can assist the provider in managing a member’s complex health needs.

SOURCE: MN Dept. of Human Services, Provider Manual, Physician and Professional Services (Telehealth), As revised Jul. 25, 2022. (Accessed Aug. 2022). 

There is reimbursement for “tele-homecare” under Elderly Waiver (EW) and Alternative Care (AC) programs.

SOURCE: MN Dept. of Human Svcs., Provider Manual, Elderly Waiver (EW) and Alternative Care (AC) Program, As revised Oct 22, 2021, (Accessed Mar. 2022).

Prior authorization for home care services is required for all tele-home-care skilled nurse visits.

SOURCE: MN Dept. of Human Svcs., Provider Manual, Home Care Svcs., As revised Feb. 10, 2021 (Accessed Mar. 2022).


CONDITIONS

MHCP covers telemonitoring services for members in high-risk, medically complex patient populations. These members have medical conditions like congestive heart failure, chronic obstructive pulmonary disease (COPD) or diabetes.

MHCP covers telemonitoring services based on the following medical necessity criteria:

  • The telemonitoring service is medically appropriate based on the member’s medical condition or status.
  • The member is cognitively and physically capable of operating the monitoring device or equipment, or the member has a caregiver who is willing and able to assist with the monitoring device or equipment.
  • The member resides in a setting that is suitable for telemonitoring and not in a setting that has health care staff on site.
  • The prescribing provider has identified and documented how telemonitoring services would likely prevent the member’s admission or readmission to a hospital, emergency room or nursing facility.
  • The results of the telemonitoring services are directly used to impact the plan of care.

Any service that does not meet medical necessity criteria will not be covered.

Bill on 837P claim format. Refer to the MN–ITS 837P Professional User Guides.

Submit claims for telemonitoring services using the CPT or HCPC code that describes the services rendered. Prior-authorization is not needed.

Provider must bill for at least 16 days of data collection within a 30 day period.

The data must be collected and transmitted rather than self-reported to the provider. The device must be defined by the FDA as a medical device.

Only MDs and practitioners may bill for remote patient monitoring (RPM) services.

Independent diagnostic testing facilities are not able to bill for RPM services.

SOURCE: MN Statute Sec. 256B.0625 Subd. 3(h); MN Dept. of Human Services, Provider Manual, Physician and Professional Services (Telehealth), As revised Jul. 25, 2022. (Accessed Aug. 2022). 


PROVIDER LIMITATIONS

The assessment and monitoring of the health data transmitted by telemonitoring must be performed by the following licensed health care professionals:

  • Advanced practice registered nurse
  • Registered nurse
  • Physician
  • Physician assistant
  • Podiatrist
  • Registered nurse
  • Respiratory therapist
  • A licensed professional working under the supervision of a medical director (for example, an LPN)

Only MDs and practitioners may bill for remote patient monitoring (RPM) services.

SOURCE: MN Statute Sec. 256B.0625 Subd. 3(h); MN Dept. of Human Services, Provider Manual, Physician and Professional Services (Telehealth), As revised Jul. 25, 2022. (Accessed Aug. 2022). 


OTHER RESTRICTIONS

Data must be collected and transmitted rather than self-reported to the provider. The device must be defined by the FDA as a medical device.

Independent diagnostic testing facilities are not able to bill for RPM services.

SOURCE: MN Dept. of Human Services, Provider Manual, Physician and Professional Services (Telehealth), As revised Jul. 25, 2022. (Accessed Aug. 2022). 

MHCP does not pay an originating site facility fee. Services billed on an outpatient claim with the GQ modifier will zero pay.

SOURCE: MN Dept. of Human Services, Physician and Professional Services (Telehealth), Jul. 25, 2022. (Accessed Aug 2022).

NOTE: Subdivision 3h, as added by Laws 2021, First Special Session chapter 7, article 6, section 12, is effective upon federal approval. The commissioner of human services shall notify the revisor of statutes when federal approval is obtained. Laws 2021, First Special Session chapter 7, article 6, section 12, the effective date.

SOURCE: MN Statute Sec. 256B.0625 Subd. 3(h). (Accessed Aug. 2022).

Last updated 08/03/2022

Store and Forward

POLICY

“Telehealth” means the delivery of health care services or consultations through the use of real time two-way interactive audio and visual communication to provide or support health care delivery and facilitate the assessment, diagnosis, consultation, treatment, education, and care management of a patient’s health care. Telehealth includes the application of secure video conferencing, store-and-forward technology, and synchronous interactions between a patient located at an originating site and a health care provider located at a distant site. Telehealth does not include communication between health care providers, or between a health care provider and a patient that consists solely of an audio-only communication, e-mail, or facsimile transmission.

SOURCE: MN Statute Sec. 256B.0625 Subd. 3b(f)(1).   (Accessed Aug. 2022).

MHCP allows payment for store-and-forward.

Store-and-forward is the asynchronous electronic transfer or transmission of a patient’s medical information or data from the originating site to a distant site for purposes of diagnostic and therapeutic assistance in the care of the patient. Medical information may include, but is not limited to, video clips, still images, X-rays, MRIs, EKGs, laboratory results, audio clips and text. The physician at the distant site reviews the case without the patient being present. Store-and-forward substitutes for an interactive encounter with the patient present; the patient is not present in real-time.

Eligible providers:

  • Physician
  • Nurse practitioner
  • Physician assistant
  • Nurse midwife
  • Clinical nurse specialist
  • Registered dietitian or nutrition professional
  • Dentist, dental hygienist, dental therapist, advanced dental therapist
  • Mental health professional, when following requirements and service limitations
  • Pharmacist
  • Certified genetic counselor
  • Podiatrist
  • Speech therapist
  • physical Therapist
  • Occupational therapist
  • Audiologist

Place of service 02 (newly redefined): Telehealth provided other than the patient’s home. It’s the location where health services and health-related services are provided or received through telecommunication technology. The patient is not located in their home when receiving health services or health-related service through telecommunication technology.

Place of service 10 (new place of service): Telehealth provided in patient’s home. The location where health services and health-related services are provided or received through telecommunication technology. Patient is located in their home (which is a location other than a hospital or other facility where the patient receives care in a private residence) when receiving health services or health-related services through telecommunication technology.

When reporting a service with place of service 02 or 10, you are certifying that you are rendering services to a patient located in an eligible originating site via an interactive audio and visual telecommunications system.

All other telehealth modifiers: All the other telehealth modifiers (GT, GQ, GO, 95) can be used for informational purposes but will not be required. The telehealth place of service codes explain that the service is rendered through telehealth. No telehealth modifiers can be used without place of service 02 or 10 or the claim will deny.

SOURCE: MN Dept. of Human Services, Provider Manual, Physician and Professional Services (Telehealth), As revised Jul. 25, 2022.  &MN Dept. of Human Services, Provider Manual, Telehealth Services, As revised Jun. 14, 2022. (Accessed Aug. 2022).


ELIGIBLE SERVICES/SPECIALTIES

See Live Video Eligible Services section for examples of eligible telemedicine services as well as noncovered services.

In addition to other requirements, refer to the following general telehealth information:

  • Out-of-state coverage policy applies to services provided via telehealth
  • Payment will be made for only one reading or interpretation of diagnostic tests such as X-rays lab tests and diagnostic assessments

SOURCE: MN Dept. of Human Services, Provider Manual, Physician and Professional Services (Telehealth), Jul 25, 2022, (Accessed Aug. 2022).

Rehabilitation Services

MHCP allows payment for expanded telehealth services, including some rehabilitation services that are normally conducted face-to-face.  Physical and occupational therapists, speech-language pathologists and audiologists may use telehealth to deliver certain covered rehabilitation therapy services that they can appropriately deliver via telehealth. Service delivered by this method must meet all other rehabilitation therapy service requirements and providers must adhere to the same standards and ethics as they would if the service was provided face-to-face.  When submitting claims for telehealth services, use place-of-service code 02 to certify that the services meets the telehealth requirements. The GQ modifier is required when billing for services via asynchronous telecommunication systems. Providers must self-attest that they meet all of the conditions of MHCP telehealth policy by completing the “Provider Assurance Statement for Telehealth”.

Limited to three sessions per week per recipient.  Payment not available for sending materials to a recipient, other providers or other facilities.

MHCP allows payment for the following services:

Store and Forward”: Transmission of medical information in a way that it is stored to be reviewed later by a physician or practitioner at the distant site (known as asynchronous transmission). Medical information may include, but is not limited to, video clips, still images, x-rays, MRIs, EKGs, laboratory results, audio clips and text. The physician at the distant site reviews the case without the patient being present. “Store and forward” services substitute for an interactive encounter with the patient present; the patient is not present in real-time.

Noncovered services:

  • Electronic connections that are not conducted over a secure encrypted website as specified by HIPAA
  • Scheduling a test or appointment
  • Clarification of issues from a previous visit
  • Reporting test results
  • Non-clinical communication
  • Communication via telephone, email or fax

Eligible providers:

  • Speech-language pathologists
  • Physical therapists
  • Physical therapist assistants
  • Occupational therapists
  • Occupational therapy assistants
  • Audiologists

Physical therapist assistants and occupational therapy assistants providing services via telehealth must follow the same supervision policy as indicated in “Rehabilitation Service Practitioners”.  There are no specific authorized distant sites or restrictions, but providers must ensure a secure transmission that meets HIPAA requirements. See manual for documentation requirements.

SOURCE: MN Dept. of Human Svcs., Provider Manual, Rehabilitation Svcs. Jan. 25, 2022 (Accessed Aug. 2022).

Store-and-Forward Telemedicine for IEP Services

MHCP will allow Minnesota public schools enrolled to provide Individualized Education Program (IEP) services and also approved to provide telehealth services, to use store-and-forward telehealth when a child is distance learning at home for the following services:

  • Physical therapy
  • Occupational therapy
  • Speech language therapy

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). Real-time, two-way interactive video with the school professional and child or parent must accompany the store-and-forward telehealth components.

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.

Use place of service 10 on claims to indicate when the child receives the health-related service via telecommunication technology in the child’s home. This is a location other than a hospital or other facility where the child receives care in a private residence.

Use place of service 02 on claims to indicate when the child receives the health-related service via telecommunication technology when the child is in a location other than a child’s home.

SOURCE: MN Dept. of Human Svcs., Provider Manual, IEP Services, As revised May 19, 2022 (Accessed Aug. 2022).


GEOGRAPHIC LIMITS

Dental

Affiliate practice or originator within Minnesota Board of Dentistry defined scope of practice must be present at originating site:

  • Dentist
  • Advanced dental therapists
  • Dental therapists
  • Dental hygienists
  • Licensed dental assistants
  • Other licensed health care professionals

Consultations performed by providers who are not located in Minnesota and contiguous counties require authorization prior to the service being provided.

SOURCE: MN Dept. of Human Svcs., Provider Manual, Dental Svcs. Mar. 14, 2022 (Accessed Aug. 2022).

Rehabilitation Services

Eligible originating sites:

  • Office of physician or practitioner
  • Hospital (inpatient or outpatient)
  • Critical access hospital (CAH)
  • Rural health clinic (RHC) and Federally Qualified Health Center (FQHC)
  • Hospital-based or CAH-based renal dialysis center (including satellites)
  • Skilled nursing facility (SNF)
  • End-stage renal disease (ESRD) facilities
  • Community mental health center
  • Dental clinic
  • Residential facilities, such as a group home and assisted living
  • Home (a licensed or certified health care provider may need to be present to facilitate the delivery of telemedicine services provided in a private home)
  • School

SOURCE: MN Dept. of Human Svcs., Provider Manual, Rehabilitation Svcs. Jan. 25, 2022 (Accessed Aug. 2022).


TRANSMISSION FEE

MHCP does not pay an originating site facility fee. Services billed on an outpatient claim with the GQ modifier will zero pay.

SOURCE: MN Dept. of Human Services, Physician and Professional Services (Telehealth), Jul. 25, 2022. (Accessed Aug. 2022).

 

Last updated 08/03/2022

Cross State Licensing

A physician licensed in another state can provide telehealth services to a patient in Minnesota if their license has never been revoked or restricted in any state, they agree to not open an office in Minnesota, not meet with patients in Minnesota or receive calls in Minnesota from patients and they annually register with the state’s board.  These requirements do not apply in response to emergency medical conditions, the services are on an irregular or infrequent basis, or the physician provides interstate telehealth services in consultation with a physician licensed in Minnesota.

SOURCE: MN Statute Sec. 147.032.  (Accessed Aug. 2022).

Last updated 08/03/2022

Definitions

“Telehealth” has the meaning given in section 62A.673, subdivision 2, paragraph (h):

“Telehealth” means the delivery of health care services or consultations through the use of real time two-way interactive audio and visual communications to provide or support health care delivery and facilitate the assessment, diagnosis, consultation, treatment, education, and care management of a patient’s health care. Telehealth includes the application of secure video conferencing, store-and-forward technology, and synchronous interactions between a patient located at an originating site and a health care provider located at a distant site. Until July 1, 2023, telehealth also includes audio-only communication between a health care provider and a patient. Telehealth does not include communication between health care providers that consists solely of a telephone conversation, e-mail, or facsimile transmission. Telehealth does not include communication between a health care provider and a patient that consists solely of an e-mail or facsimile transmission. Telehealth does not include telemonitoring services.

SOURCE: MN Statute Sec 147.033. (Accessed Aug. 2022).

Chemical Dependency Licensed Treatment Facilities

“Telehealth” means the delivery of a substance use disorder treatment service while the client is at an originating site and the health care provider is at a distant site via telehealth as defined in section 256B.0625, subdivision 3b, and as specified in section 254B.05, subdivision 5, paragraph (f).

SOURCE: MN Statute Section 245G.01, Subd. 26.  (Accessed Aug. 2022).

 

Last updated 08/03/2022

Licensure Compacts

Minnesota is a member of the Interstate Medical Licensure Compact.

SOURCE: Interstate Medical Licensure Compact. (Accessed Aug. 2022).

Member of the Psychology Interjurisdictional Compact (PSYPACT).

SOURCE: PSYPACT, Compact Map, (Accessed Aug. 2022).

 

*See Compact websites for implementation and license issuing status and other related requirements.

Last updated 08/03/2022

Miscellaneous

Chemical Dependency Licensed Treatment Facilities

“Face-to-face” means two-way, real-time, interactive and visual communication between a client and a treatment service provider and includes services delivered in person or via telehealth.

SOURCE: MN Statutes  254G.01. (Accessed Aug. 2022).

The amendments to subdivisions 13 and 26 by Laws 2021, First Special Session chapter 7, article 6, sections 4 and 5, are effective July 1, 2021, or upon federal approval, whichever is later. The commissioner of human services shall notify the revisor of statutes when federal approval is obtained. Laws 2021, First Special Session chapter 7, article 6, sections 4 and 5, the effective dates.

SOURCE: Minnesota Session Laws – 2021, 1st Special Session. (Accessed Aug. 2022).

Last updated 08/03/2022

Online Prescribing

A physician-patient relationship may be established through telehealth.

“Telehealth” has the meaning given in section 62A.673, subdivision 2, paragraph (h).

SOURCE: MN Statute 147.033. (Accessed Aug. 2022).

A prescription drug order for the following drugs is not valid, unless it can be established that the prescription drug order was based on a documented patient evaluation, including an examination, adequate to establish a diagnosis and identify underlying conditions and contraindications to treatment:

  • Controlled substance drugs listed in section 152.02, subdivisions 3 to 5;
  • Drugs defined by the Board of Pharmacy as controlled substances under section 152.02, subdivisions 7, 8, and 12;
  • Muscle relaxants;
  • Centrally acting analgesics with opioid activity;
  • Drugs containing butalbital; or
  • Phosphodiesterase type 5 inhibitors when used to treat erectile dysfunction.

The requirement for an examination shall be met if:

An in-person examination has been completed in any of the following circumstances:

  • The prescribing practitioner examines the patient at the time the prescription or drug order is issued;
  • The prescribing practitioner has performed a prior examination of the patient;
  • Another prescribing practitioner practicing within the same group or clinic as the prescribing practitioner has examined the patient;
  • A consulting practitioner to whom the prescribing practitioner has referred the patient has examined the patient; or
  • The referring practitioner has performed an examination in the case of a consultant practitioner issuing a prescription or drug order when providing services by means of telehealth; or

The prescription order is for a drug listed in paragraph (d), clause (6), or for medication-assisted therapy for a substance use disorder, and the prescribing practitioner has completed an examination of the patient via telehealth as defined in section 62A.673, subdivision 2, paragraph (h).

SOURCE: MN Statute Sec. 151.37 Subd. 2(d) & (e).(Accessed Aug. 2022).

For purposes of a provider prescribing ophthalmic goods, the provider must establish a provider-patient relationship through one of the following methods:

  1. In person;
  2. Face-to-face interactive, two-way, real-time communication; or
  3. Through store-and-forward technologies when all of the following conditions are met: The provider obtains an updated medical history and makes a diagnosis at the time of prescribing; the provider conforms to the standard of care expected of in-person care as appropriate to the patient’s age and presenting condition, including when the standard of care requires the use of diagnostic testing and performance of a physical examination, which may be carried out through the use of peripheral devices appropriate to the patient’s condition; the ophthalmic prescription is not determined solely by use of an online questionnaire; the provider is licensed and authorized to issue an ophthalmic prescription in MN; and upon request, the provider provides patient records in a timely manner.

SOURCE:  MN Statute Sec. 145.713, Subd. 4, (Accessed Aug. 2022). 

Medical Cannabis

For issuing a written certification of qualifying condition, an in-person physical examination of the patient must take place an cannot be performed by remote means, including telehealth or via the Internet.

SOURCE: MN Administrative Rule. 4770.4014, Subpart 2(B)(1). (Accessed Aug. 2022).

Last updated 08/03/2022

Professional Boards Standards

No Reference Found