Recuperative care providers may get reimbursed for the recuperative care health services rate and the recuperative care facility rate. Providers can bill for services only after their MHCP enrollment has been approved.

Refer to the following information for definitions and payment rates.

Recuperative Care Health Services Rate

  • The recuperative care health services rate is a bundled per diem payment of $300.00 per day for the covered services provided to the member. Services provided within the bundled payment may include, but are not limited to, the covered services.
  • Legislative increase and decrease rates for certain services may be applied to the per diem payment of $300.00 per day. This may result in a reimbursement that is less than the per diem payment of $300.00 per day. Refer to Payment Methodology – Non-Hospital under Provider Basics in the MHCP Provider Manual for more information.

Note: If the member has both Medicare and Medical Assistance coverage, bill directly to MHCP. Medicare does not cover the recuperative care health services rate (bundled payment).

Recuperative Care Health Services Claim (Professional Claim)

  • Bill on 837P claim format. Refer to the MN–ITS 837P Professional User Guides.
  • Bill CPT code T2033 for the recuperative care bundled payment per date of service (DOS).
  • Additionally, you are required to bill for all the applicable CPT or HCPCS codes for every recuperative care health service that is rendered for the T2033 bundle rate per date of service.
  • Bill per service line, per date of service (do not bill one service line with a span or multiple dates of services)
  • Bill each recuperative care health services rendered with a $0.00 charge (these will be zero pay).
  • Bill all CPT or HCPCS codes on the same claim as T2033 according to the DOS.
  • Report the enrolled MHCP MD, PA or APRN NPI as the rendering provider who is supervising health services. This provider must be reported on the Recuperative Care – Health Services Provider Acknowledgment (DHS-8562)
  • If the recuperative care facility affiliates with an advance practice professional: The recuperative care facility can bill for the recuperative care health services claim (professional claim) for providing the services. The recuperative care facility would report their supervising MHCP enrolled advance practice provider on the claim as the rendering provider.

or

  • If the recuperative care facility affiliates with health services group provider: The health services group providers will bill the recuperative care health services (professional claim) for providing the services. The health service group would report their supervising MHCP enrolled advance practice provider on the claim as the rendering provider. The recuperative care facility will not be able to bill for the health services rate because they did not provide the service.
  • One of the ICD-10 diagnosis codes for homelessness.
  • At least one ICD-10 diagnosis code for the member medical condition.
  • It is the provider’s responsibility to determine the appropriate diagnosis code for the service that was provided.

Recuperative Care Facility Rate
The recuperative care facility rate is approximately $34.00 per day. This includes the room and board daily rate.

Recuperative Care Facility Claim

  • Bill on 837I claim format on 86X type of bill for residential facility. Refer to the MN–ITS 837I Institutional User Guides.
  • One ICD-10 diagnosis code for homelessness.
  • At least one ICD-10 diagnosis code for the member’s medical condition.
  • It is the provider’s responsibility to determine the appropriate diagnosis code for the service that was provided.
  • Revenue code 0169
  • Condition code 17

Note: The recuperative care health services (professional) claim must be submitted and paid before submitting the recuperative care facility claim. We reimburse the recuperative care facility rate only when the recuperative care health services rate is reimbursed to a provider. Providers may opt to only receive the recuperative care health services rate. The eligibility standards in chapter 256I do not apply to the recuperative care facility rate.

Documentation

You need to maintain health records on each member. Refer to Minnesota Rules, 9505.2175 on health service records documentation for more information.