Note: This webpage is under development. The material on this page is draft and is presented for illustrative purposes only. This page has not yet been reviewed with the Minnesota Administrative Uniformity Committee (AUC) and may be subject to change or removal.

The AUC Medical Code Technical Advisory Group (TAG) provides clarification and answers to frequently asked questions about recommended ways to code for health and medical services and also addresses new code standards pertaining to administrative simplification uniformity in Minnesota. The information and resources on this page are valuable and should be used for efficient, accurate medical coding and in meeting a broader statewide goal of greater health care administrative uniformity and consistency to reduce health care administrative costs and burdens.

Claim Type

The AUC has identified a number of questions and requests for clarification regarding the claim type to be submitted under a variety of scenarios. Below is a list of scenarios and the type of claim to be submitted for the each of the scenarios listed. (The following is provided for general information only. For additional information, see resources such as …)

Outpatient professional services provided by Critical Access Hospitals (CAH), Method II billing:

Outpatient professional services provided by CAH electing Method II billing should be reported on the professional claim type (i.e. 837P).

Rural Health Clinics/Federal Qualified Health Centers:

Report on the claim type with procedure codes appropriate to the services provided, e.g., physician/clinic services on the 837P, dental services on the 837D, pharmacy on NCPDP.

Ambulatory Surgical Centers:

Per trading partner agreement, either the 837P or the 837I claim type is allowed. Check with payer to determine the preferred billing method.

Indian Health Services:

Report on the claim type with procedure codes appropriate to the services provided, e.g., physician/clinic services on the 837P, dental services on the 837D, pharmacy on NCPDP.

Modifier 50 and Bilateral Procedures

The AUC has identified a number of questions and requests for clarification regarding coding for modifier 50 and bilateral procedures under a variety of scenarios. Below is a list of modifier and bilateral procedure scenarios with coding information for each of the scenarios listed. (The following is provided for general information only. For additional information, see resources such as …)

Modifier 50 – Physician services:

Modifier 50 should only be used on surgical services that can be performed bilaterally and are not already defined as a bilateral service. Bilateral services are to be reported with the 50 modifier on one line with one unit.

Modifier 50 -- Ambulatory Surgical Centers:

Modifier 50 should be used on surgical services that can be performed bilaterally and are not already defined as a bilateral service. When appropriate, report the service appended with the 50 modifier on one line with one unit.

Bilateral Radiology -- radiology services and other diagnostic procedures:

Bilateral radiology services are reported as either:
1. one line with a 50 modifier and one unit, or
2. two separate lines, one with RT modifier and one with LT modifier.

Bilateral Radiology -- physician services:

Bilateral radiology services are reported as either:
1. one line with a 50 modifier and one unit, or
2. two separate lines, one with RT modifier and one with LT modifier.

Bilateral Radiology -- Ambulatory Surgical Centers:

Professional bilateral radiology services are reported as two separate lines, one with RT modifier and one with LT modifier.

Coding Information for State Medicaid Agency (MN Department of Human Services) Selected Programs/Services

The Minnesota Department of Human Services (DHS) is the state’s single largest health care purchaser and administers a broad range of publicly funded Minnesota Health Care Programs (MHCP) and services. DHS provides resources and information regarding MHCP and related services on its Provider Manual webpages and other webpages.

The AUC Medical Code TAG (MCT) has identified several DHS programs and services as of particular interest to medical coders because they were perhaps recently implemented or modified, are complex, less well known, and for other similar reasons.

The MCT has created a list of “shortcuts” (links) to the DHS provider manual or other resources below with more information regarding topics it has identified as of possible interest. The MCT will periodically review and update the list below. Please see the DHS Provider Manual for medical coding and other information on additional MHCP topics of interest.

Substance Abuse Services

Hospitals

Substance Abuse Services: Hospital

(Facility licensed as a hospital under Minnesota statutes, section 144.50 to 144.56)

Service Description	Option 1 or 2 *	Unit	Revenue Code	HCPCS Procedure Code	Claim Type	Type of Bill
Room and Board	1	Day	0118, 0128, 0138, 0148, 158	N/A	837I	011x - Hospital Inpatient
Detox	1	Day	0116, 0126, 0136, 0146, 0156	N/A	837I	011x - Hospital Inpatient
Treatment component	1	Day	Choose one per date of service: 0944 or 0945 or 0949	N/A	837I	011x - Hospital Inpatient
Ancillary	1	Based on revenue code	As appropriate	N/A	837I	011x - Hospital Inpatient
All-inclusive Room and Board	2	Day	0101	N/A	837I	011x - Hospital Inpatient
Detox	2	Day	0116, 0126, 0136, 0146, 0156	N/A	837I	011x - Hospital Inpatient
Ancillary Services	2	Based on revenue code	As appropriate	N/A	837I	011x - Hospital Inpatient

*Note:
“Option 1” treatment is reported separately from room and board.
“Option 2” is all-inclusive: includes room and board and treatment.

All Other Residential

Substance Abuse Services: All Other Residential

Service Description	Unit	Revenue Code	HCPCS Procedure Code	Claim Type	Type of Bill
Room and Board	Day	1002: (residentially licensed chemical dependency treatment provider, e.g., Rule 31 Licensed Facility, Children’s Residential Facility with CD certification, Tribal CD licensed facility) 1003: (facilities licensed to provide room and board services only, e.g., board and lodge, supervised living facility, foster care)	None	837I	086x - Special Facility, Residential
Detox	Day	0116, 0126, 0136, 0146, 0156	None	837I	086x - Special Facility, Residential
Treatment Program, Treatment Component	Day	Choose one per date of service: 0944 or 0945 or 0949	None	837I	086x - Special Facility, Residential
Treatment Program, Treatment Component	Hour	0953	None	837I	086x - Special Facility, Residential
Ancillary Services	Based on revenue code	As appropriate	None	837I	086x - Special Facility, Residential

Outpatient Services, (a) Institutional, (b) Professional Claim Type

Substance Abuse Services: Outpatient Services - Claim Type 837 Institutional

(Applicable to all providers and settings per applicable contract or established program standards)

Service Description	Unit	Revenue Code	HCPCS Procedure Code	Claim Type	Type of Bill
Alcohol and/or drug assessment	Session/visit	0900	H0001	837I	As appropriate
Outpatient program; Treatment only	Hour	0944 or 0945 or 0953	H2035 HQ (group) H2035 (individual)	837I	089x or 013x
Medication Assisted Therapy (MAT)	Day	0944	H0020	837I	089x or 013x
MAT – all other drugs Note: U9 – MAT, all other drugs, e.g. buprenorphine, naltrexone, Antabuse, etc.	Day	0944	H0047 U9	837I	089x or 013x
Outpatient Ancillary Services	Based on revenue code	As appropriate		837I	089x or 013x

Note:
Take-home doses place of service guide: The POS for directly observed administration would be 11 or 22. Additional days where the patient self-administers the doses should be reported with POS 12.

Substance Abuse Services: Outpatient Services - Claim Type 837 Professional

(Applicable to all providers and settings per applicable contract or established program standards)

Service Description	Unit	Revenue Code	HCPCS Procedure Code	Claim Type	Type of Bill
Alcohol and/or drug assessment	Session/visit	N/A	H0001	837P
Outpatient program; Treatment only	Hour	N/A	H2035 HQ (group) H2035 (individual)	837P	N/A
Medication Assisted Therapy (MAT)	Day	N/A	H0020	837P	N/A
MAT – all other drugs	Day	N/A	H0047 U9	837P	N/A
MAT Plus	Day	N/A	H0020 UA	837P	N/A
MAT Plus – all other drugs	Day	N/A	H0047 UB	837P	N/A

MAT Plus – a licensed program providing at least 9 hours of treatment service per week

U9 – MAT, all other drugs, e.g. buprenorphine, naltrexone, Antabuse, etc.

UA – MAT Plus, methadone

UB – MAT Plus, all other drugs

Maternal and Child Health Billing Guide for Public Health Agencies

Public Health Nurse Clinic Services

Service	Home or Place of Residence (Use appropriate POS)	Public Health Clinic (POS 71)
Services Include: Health Promotion and Counseling Nursing Assessment and Diagnostic Testing Medication Management Nursing Treatment Nursing Care, in the home, by RN (PHN & CPHN)	S9123 For Evidence-Based Public Health Home Nurse Visits pursuant to Minnesota Statues, section 256B.7635, use S9123 with the U8 modifier (S9123 US)	T1015
Home health aide or CNA, per visit	T1021	T1021
Patient Education only – if no other services (includes car seat education)	Individual S9445 Group S9446	Individual S9445 Group S9446

Maternal and Child Health Visits

Service	Home or Place of Residence (Use appropriate POS)	Public Health Clinic (POS 71)
Birthing Classes	N/A	S9442
Home Visit for Postnatal assessment and follow up care - Mother	99501	N/A
Home Visit for Postnatal assessment and follow up care - Newborn	99502	N/A

Enhanced Services: For at-risk pregnancies as determined by the physician/nurse practitioner:

Service	Home or Place of Residence (Use appropriate POS)	Public Health Clinic (POS 71)
At-Risk Antepartum Management	H1001	H1001
At-Risk Care Coordination	H1002	H1002
At-Risk Prenatal Health Education	H1003	H1003
At-Risk Prenatal Health Education I	H1003	H1003
At-Risk Prenatal Health Education II	H1003	H1003
At-Risk Enhanced Service; Follow-up Home Visit	H1004	N/A
At-Risk Enhanced Service Package	H1005	H1005

Prenatal Nutrition Education, Medical Nutrition Therapy

Service	Home or Place of Residence (Use appropriate POS)	Public Health Clinic (POS 71)
Prenatal Nutrition Education, Medical Nutrition Therapy; initial assessment and intervention, individual, face-to-face with patient, each 15 minutes	97802	97802
Prenatal Nutrition Education, Medical Nutrition Therapy; initial re-assessment and intervention, individual, face-to-face with patient, each 15 minutes	97803	97803

Other Services

Miscellaneous

Service	Home or Place of Residence (Use appropriate POS)	Public Health Clinic (POS 71)
Maternal Depression Screenings	96161	96161
Child Developmental Screenings	96110	96110
Autism Screening	96110 U1	96110 U1
Child Social/Emotional or Mental Health Screenings	96127	96127
TB Case Management	T1016	T1016
TB Direct Observation Therapy	H0033	H0033