Name of Manual - Blue Cross and Blue Shield of Minnesota

Coding Policies and Guidelines (Public Programs)
Community Health
Workers
(continued)
Billing
CHW services should be billed to Blue Plus as follows:
Claims format: Professional (837P)
Codes: 98960, 98961, 98962 or D1206
Provider Number: Enter the Blue Plus individual provider
number or UMPI number of the CHW on each service line
Diagnosis: Enter a valid ICD-9-CM diagnosis(es) on the claim
and link to the appropriate service line
Reimbursement
Blue Plus will utilize our standard public programs pricing
methodology for reimbursement of CHW services.
Newborn Circumcision For members of MCHP, claims payment for newborn circumcision
is the responsibility of Blue Plus. Circumcision coverage is limited
to only those procedures that are medically necessary (a pathologic
condition exists that requires circumcision). This limitation applies
to circumcision for all ages. The newborn circumcision exception
for religious practice was eliminated.
11-14
A prior authorization will be required for all circumcisions for
determination of medical necessity.
Member Eligibility
This legislative change in circumcision benefits and claims
processing applies to members in all MHCP products:
MHCP Product Name Group Number
Begins With
Blue Plus: Blue Advantage
(PMAP, & MCS+)
PP01, PP02, PP03,
PP04, PP05, PP06,
PP07, PP08, PP09
Members
Alpha Prefix
XZG
Blue Plus: MinnesotaCare PP1 XZG
Blue Plus: SecureBlue PP3 XZS
Blue Plus: CareBlue PP3 XZS
Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (02/07/12)