Behavioral health providers
Certain behavioral health drugs are offered orally or as an injectable. Drugs offered as an injectable (excluding immunizations) need to be administered in an inpatient setting by a home health professional, in a skilled nursing facility by a practitioner or in an outpatient setting by a practitioner.
According to the Minnesota State Statute 256B.0625, Covered Services, Subd. 13e, Payment Rates, “A retail or specialty pharmacy dispensing a drug for administration in an outpatient setting is not eligible for direct reimbursement.” Therefore, it is imperative that providers obtain the drug from a source other than a retail or specialty pharmacy and bill MHP/Hennepin Health for the drug using the appropriate J code.
Effective April 15, 2016, MHP/Hennepin Health will require injectable drugs commonly administered in an outpatient setting to be billed using a J code.
Submit the claim electronically using a Professional 837 Form.
The administering facility or practitioner need to submit their claims with the appropriate coding for its administration and an associated office visit.
Procure the drug from a source other than a retail or specialty pharmacy.
Examples of injectable drugs include, but are not limited to: