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Data from 2023 calendar year

Table 1. Number of children (1-6 years old) who received a diagnostic assessment

MCO Number of children (ages 1-3) Number of children (ages 4-6)
Blue Plus 477 2,059
HealthPartners 267 913
Hennepin Health 22 52
Itasca Medical Care 4 65
Medica 5 33
PrimeWest 45 313
South Country Health Alliance 23 131
UCare 486 1,838
UnitedHealthcare 26 95
MCOs overall 1,355 5,499


Table 2. Number of children (1-6 years old) with a diagnosis of autism spectrum disorder (ASD) who received treatments

MCO Number of children with ASD Number of children with treatment(s)
Blue Plus 1,393 1,022
HealthPartners 822 631
Hennepin Health 53 41
Itasca Medical Care 33 18
Medica 43 33
PrimeWest 194 133
South Country Health Alliance 112 62
UCare 1,826 1,379
UnitedHealthcare 115 69
MCOs overall 4,591 3,388


Table 3. Number of children (1-6 years old) who received a diagnostic assessment, by procedure code and age

Procedure code Number of children (1-3 years old) Number of children (4-6 years old)
90785 563 2,175
90791 1,024 4,461
90792 14 142
90887 17 125
96116 5 122
96130 311 935
96138 132 335
96146 0 12
97151 230 550


Table 4. Number of children (1-6 years old) who received a diagnostic assessment, by procedure code and MCO

MCO 90785 90791 90792 90887 96116 96130 96138 96146 97151
Blue Plus 6,204 2,372 82 66 69 504 139 6 1,052
HealthPartners 2,972 1,120 39 11 25 233 68 0 535
Hennepin Health 188 69 0 1 3 17 9 0 16
Itasca Medical Care 161 55 4 7 7 4 3 0 7
Medica 75 30 1 1 0 7 3 0 3
PrimeWest 1,118 343 21 16 3 58 18 6 132
South Country Health Alliance 456 155 4 11 1 20 4 0 40
UCare 5,342 2,151 28 29 58 555 220 4 1,141
UnitedHealthcare 296 99 1 3 5 25 16 0 14
MCOs overall 16,812 6,394 180 145 171 1,423 480 16 2,940


Table 5a. Number of children (1-3 years old) with a diagnosis of ASD who received treatments, by MCO and age

MCO # 1-year-olds with ASD # 1-year-olds who received treatments # 2-year-olds with ASD # 2-year-olds who received treatments # 3-year-olds with ASD # 3-year-olds who received treatments
Blue Plus 14 9 116 92 245 194
HealthPartners 4 2 63 55 148 119
Hennepin Health 0 0 7 6 8 7
Itasca Medical Care 0 0 2 2 3 3
Medica 0 0 4 3 11 9
PrimeWest 0 0 10 6 27 22
South Country Health Alliance 0 0 5 1 20 12
UCare 11 7 141 114 340 273
UnitedHealthcare 1 1 14 8 14 10
MHCP overall 30 19 362 287 816 649


Table 5b. Number of children (4-6 years old) with a diagnosis of ASD who received treatments, by MCO and age

MCO # 4-year-olds with ASD # 4-year-olds who received treatments # 5-year-olds with ASD # 5-year-olds who received treatments # 6-year-olds with ASD # 6-year-olds who received treatments
Blue Plus 337 260 348 249 333 218
HealthPartners 209 171 210 164 188 120
Hennepin Health 10 7 11 7 17 14
Itasca Medical Care 10 5 5 2 13 6
Medica 10 9 10 8 8 4
PrimeWest 48 31 53 36 56 38
South Country Health Alliance 30 16 28 14 29 19
UCare 455 348 438 323 441 314
UnitedHealthcare 20 10 31 19 35 21
MHCP overall 1,129 857 1,134 822 1,120 754


Table 6a. Blue Plus: Types of treatments provided to children with ASD by procedure code (n=1,393)

Procedure code Description Unique # of children who receive service Count of services Total units submitted Average units
90832 Psychotherapy, 30 min 63 154 155.0 2.5
90833 Psychotherapy with E&M, 30 minutes 14 51 51.0 3.6
90834 Psychotherapy, 45 min 125 511 511.0 4.1
90836 Psychotherapy with E&M, 45 min 2 2 2.0 1.0
90837 Psychotherapy, 60 min 169 1,146 1,152.0 6.8
90838 Psychotherapy with E&M, 60 min 0 0 0.0 0.0
90839 Psychotherapy for Crisis, first 60 minutes 1 1 1.0 1.0
90840 Psychotherapy for Crisis, over 74 minutes 0 0 0.0 0.0
90846 Family Psychotherapy - Without Patient Present 256 964 964.0 3.8
90847 Family Psychotherapy - With Patient Present 197 910 910.0 4.6
90849 Multiple Family Group Psychotherapy 4 36 36.0 9.0
90853 Group Psychotherapy 3 8 8.0 2.7
90887 Interpretation of Psychiatric and Other Medical Examination 7 7 7.0 1.0
90899 Unlisted Psychiatric Service 30 81 81.0 2.7
97153 EIDBI Intervention – Individual: Adaptive behavior treatment by protocol 180 54,246 470,509.0 2,613.9
97154 EIDBI Intervention – Group: Group adaptive behavior treatment by protocol 76 10,613 32,687.0 430.1
97155 Intervention - Individual: Observation and Direction: Adaptive behavior treatment with protocol modification 180 16,586 101,751.0 565.3
97156 Family/Caregiver Training and Counseling: Individual: Family adaptive behavior treatment guidance 154 2,000 8,142.0 52.9
97157 Multiple Family Group Adaptive Behavior Treatment Guidance 5 18 55.0 11.0
99499 Unlisted Evaluation and Management Service 2 2 2.0 1.0
H0031 Administering and Reporting Standardized Measures 246 492 492.0 2.0
H0032 - CTSS Individual Treatment Plan Development and Monitoring (Children’s Therapeutic Services & Supports) 156 444 489.0 3.1
H0032 - EIDBI Individual Treatment Plan Development and Monitoring (Early Intensive Developmental and Behavioral Intervention) 224 9,895 10,394.0 46.4
H2012 Behavioral Health Day Treatment (General Day Treatment) 69 5,551 16,286.0 236.0
H2014 Skills Training 80 2,133 28,310.0 353.9
H2015 Crisis Assistance 3 4 6.0 2.0
H2019 Mental Health Behavioral Aide 0 0 0.0 0.0
T1013 Sign Language or Oral Interpreter Services 117 900 3,524.0 30.1
T1024 Evaluation and Treatment by Integrated, Specialty Team 73 297 357.0 4.9


Table 6b. Blue Plus: Types of treatments provided to children with ASD by category of service (n=1,393)

Category of service Description Unique # of children who receive service Count of services Total units submitted Average units
054 Occupational Therapy 643 17,114 41,459 64.5
051 Physical Therapy 149 2,816 4,804.0 32.2
053 Speech Therapy 655 16,783 16,791.0 25.6


Table 7a. HealthPartners: Types of treatment provided to children with ASD by procedure code (n=822)

Procedure code Description Unique # of children who receive service Count of services Total units submitted Average units
90832 Psychotherapy, 30 min 21 78 78.0 3.7
90833 Psychotherapy with E&M, 30 minutes 3 5 5.0 1.7
90834 Psychotherapy, 45 min 54 288 288.0 5.3
90836 Psychotherapy with E&M, 45 min 0 0 0.0 0.0
90837 Psychotherapy, 60 min 57 331 331.0 5.8
90838 Psychotherapy with E&M, 60 min 0 0 0.0 0.0
90839 Psychotherapy for Crisis, first 60 minutes 1 1 1.0 1.0
90840 Psychotherapy for Crisis, over 74 minutes 0 0 0.0 0.0
90846 Family Psychotherapy - Without Patient Present 217 847 847.0 3.9
90847 Family Psychotherapy - With Patient Present 121 435 435.0 3.6
90849 Multiple Family Group Psychotherapy 6 91 91.0 15.2
90853 Group Psychotherapy 0 0 0.0 0.0
90887 Interpretation of Psychiatric and Other Medical Examination 4 4 4.0 1.0
90899 Unlisted Psychiatric Service 22 37 37.0 1.7
97153 EIDBI Intervention – Individual: Adaptive behavior treatment by protocol 100 29,446 241,124.0 2,411.2
97154 EIDBI Intervention – Group: Group adaptive behavior treatment by protocol 52 10,021 30,846.0 593.2
97155 Intervention - Individual: Observation and Direction: Adaptive behavior treatment with protocol modification 99 8,694 50,650.0 511.6
97156 Family/Caregiver Training and Counseling: Individual: Family adaptive behavior treatment guidance 81 1,175 3,888.0 48.0
97157 Multiple Family Group Adaptive Behavior Treatment Guidance 1 1 4.0 4.0
99499 Unlisted Evaluation and Management Service 0 0 0.0 0.0
H0031 Administering and Reporting Standardized Measures 176 370 370.0 2.1
H0032 - CTSS Individual Treatment Plan Development and Monitoring (Children’s Therapeutic Services & Supports) 103 325 325.0 3.2
H0032 - EIDBI Individual Treatment Plan Development and Monitoring (Early Intensive Developmental and Behavioral Intervention) 107 5,167 5,231.0 48.9
H2012 Behavioral Health Day Treatment (General Day Treatment) 83 9,642 28,482.0 343.2
H2014 Skills Training 25 331 2,810.0 112.4
H2015 Crisis Assistance 1 1 2.0 2.0
H2019 Mental Health Behavioral Aide 0 0 0.0 0.0
T1013 Sign Language or Oral Interpreter Services 100 1,224 5,119.0 51.2
T1024 Evaluation and Treatment by Integrated, Specialty Team 35 215 229.0 6.5


Table 7b. HealthPartners: Types of treatment provided to children with ASD by category of service (n=822)

Category of service Description Unique # of children who receive service Count of services Total units submitted Average units
054 Occupational Therapy 430 14,232 25,821 60.0
051 Physical Therapy 256 14,631 15,823.0 61.8
053 Speech Therapy 464 15,181 15,189.0 32.7


Table 8a. Hennepin Health: Types of treatment provided to children with ASD by procedure code (n=53)

Procedure code Description Unique # of children who receive service Count of services Total units submitted Average units
90832 Psychotherapy, 30 min 2 2 2.0 1.0
90833 Psychotherapy with E&M, 30 minutes 0 0 0.0 0.0
90834 Psychotherapy, 45 min 7 34 34.0 4.9
90836 Psychotherapy with E&M, 45 min 0 0 0.0 0.0
90837 Psychotherapy, 60 min 6 35 35.0 5.8
90838 Psychotherapy with E&M, 60 min 0 0 0.0 0.0
90839 Psychotherapy for Crisis, first 60 minutes 0 0 0.0 0.0
90840 Psychotherapy for Crisis, over 74 minutes 0 0 0.0 0.0
90846 Family Psychotherapy - Without Patient Present 18 76 76.0 4.2
90847 Family Psychotherapy - With Patient Present 8 17 17.0 2.1
90849 Multiple Family Group Psychotherapy 0 0 0.0 0.0
90853 Group Psychotherapy 0 0 0.0 0.0
90887 Interpretation of Psychiatric and Other Medical Examination 0 0 0.0 0.0
90899 Unlisted Psychiatric Service 1 3 3.0 3.0
97153 EIDBI Intervention – Individual: Adaptive behavior treatment by protocol 7 901 9,053.0 1,293.3
97154 EIDBI Intervention – Group: Group adaptive behavior treatment by protocol 3 558 1,368.0 456.0
97155 Intervention - Individual: Observation and Direction: Adaptive behavior treatment with protocol modification 7 151 594.0 84.9
97156 Family/Caregiver Training and Counseling: Individual: Family adaptive behavior treatment guidance 3 51 152.0 50.7
97157 Multiple Family Group Adaptive Behavior Treatment Guidance 0 0 0.0 0.0
99499 Unlisted Evaluation and Management Service 0 0 0.0 0.0
H0031 Administering and Reporting Standardized Measures 15 31 31.0 2.1
H0032 - CTSS Individual Treatment Plan Development and Monitoring (Children’s Therapeutic Services & Supports) 9 261 261.0 29.0
H0032 - EIDBI Individual Treatment Plan Development and Monitoring (Early Intensive Developmental and Behavioral Intervention) 6 124 124.0 20.7
H2012 Behavioral Health Day Treatment (General Day Treatment) 6 542 1,609.0 268.2
H2014 Skills Training 2 449 7,044.0 3,522.0
H2015 Crisis Assistance 0 0 0.0 0.0
H2019 Mental Health Behavioral Aide 0 0 0.0 0.0
T1013 Sign Language or Oral Interpreter Services 5 33 75.0 15.0
T1024 Evaluation and Treatment by Integrated, Specialty Team 3 4 4.0 1.3


Table 8b. Hennepin Health: Types of treatment provided to children with ASD by category of service (n=53)

Category of service Description Unique # of children who receive service Count of services Total units submitted Average units
054 Occupational Therapy 29 1,022 2,950 101.7
051 Physical Therapy 6 132 267.0 44.5
053 Speech Therapy 26 731 731.0 28.1


Table 9a. Itasca Medical Care: Types of treatment provided to children with ASD by procedure code (n=33)

Procedure code Description Unique # of children who receive service Count of services Total units submitted Average units
90832 Psychotherapy, 30 min 3 4 4.0 1.3
90833 Psychotherapy with E&M, 30 minutes 0 0 0.0 0.0
90834 Psychotherapy, 45 min 1 1 1.0 1.0
90836 Psychotherapy with E&M, 45 min 0 0 0.0 0.0
90837 Psychotherapy, 60 min 5 38 38.0 7.6
90838 Psychotherapy with E&M, 60 min 0 0 0.0 0.0
90839 Psychotherapy for Crisis, first 60 minutes 0 0 0.0 0.0
90840 Psychotherapy for Crisis, over 74 minutes 0 0 0.0 0.0
90846 Family Psychotherapy - Without Patient Present 2 2 2.0 1.0
90847 Family Psychotherapy - With Patient Present 1 4 4.0 4.0
90849 Multiple Family Group Psychotherapy 0 0 0.0 0.0
90853 Group Psychotherapy 0 0 0.0 0.0
90887 Interpretation of Psychiatric and Other Medical Examination 0 0 0.0 0.0
90899 Unlisted Psychiatric Service 0 0 0.0 0.0
97153 EIDBI Intervention – Individual: Adaptive behavior treatment by protocol 2 56 839.0 419.5
97154 EIDBI Intervention – Group: Group adaptive behavior treatment by protocol 0 0 0.0 0.0
97155 Intervention - Individual: Observation and Direction: Adaptive behavior treatment with protocol modification 1 2 20.0 20.0
97156 Family/Caregiver Training and Counseling: Individual: Family adaptive behavior treatment guidance 1 6 38.0 38.0
97157 Multiple Family Group Adaptive Behavior Treatment Guidance 0 0 0.0 0.0
99499 Unlisted Evaluation and Management Service 0 0 0.0 0.0
H0031 Administering and Reporting Standardized Measures 0 0 0.0 0.0
H0032 - CTSS Individual Treatment Plan Development and Monitoring (Children’s Therapeutic Services & Supports) 2 2 2.0 1.0
H0032 - EIDBI Individual Treatment Plan Development and Monitoring (Early Intensive Developmental and Behavioral Intervention) 2 17 24.0 12.0
H2012 Behavioral Health Day Treatment (General Day Treatment) 1 9 9.0 9.0
H2014 Skills Training 3 99 461.0 153.7
H2015 Crisis Assistance 0 0 0.0 0.0
H2019 Mental Health Behavioral Aide 0 0 0.0 0.0
T1013 Sign Language or Oral Interpreter Services 0 0 0.0 0.0
T1024 Evaluation and Treatment by Integrated, Specialty Team 1 2 2.0 2.0


Table 9b. Itasca Medical Care: Types of treatment provided to children with ASD by category of service (n=33)

Category of service Description Unique # of children who receive service Count of services Total units submitted Average units
054 Occupational Therapy 7 84 161 23.0
051 Physical Therapy 4 33 69.0 17.3
053 Speech Therapy 12 149 149.0 12.4


Table 10a. Medica: Types of treatment provided to children with ASD by procedure code (n=43)

Procedure code Description Unique # of children who receive service Count of services Total units submitted Average units
90832 Psychotherapy, 30 min 2 3 3.0 1.5
90833 Psychotherapy with E&M, 30 minutes 0 0 0.0 0.0
90834 Psychotherapy, 45 min 4 5 5.0 1.3
90836 Psychotherapy with E&M, 45 min 0 0 0.0 0.0
90837 Psychotherapy, 60 min 3 7 7.0 2.3
90838 Psychotherapy with E&M, 60 min 0 0 0.0 0.0
90839 Psychotherapy for Crisis, first 60 minutes 1 1 1.0 1.0
90840 Psychotherapy for Crisis, over 74 minutes 0 0 0.0 0.0
90846 Family Psychotherapy - Without Patient Present 10 58 58.0 5.8
90847 Family Psychotherapy - With Patient Present 2 3 3.0 1.5
90849 Multiple Family Group Psychotherapy 0 0 0.0 0.0
90853 Group Psychotherapy 0 0 0.0 0.0
90887 Interpretation of Psychiatric and Other Medical Examination 0 0 0.0 0.0
90899 Unlisted Psychiatric Service 2 4 4.0 2.0
97153 EIDBI Intervention – Individual: Adaptive behavior treatment by protocol 3 142 1,233.0 411.0
97154 EIDBI Intervention – Group: Group adaptive behavior treatment by protocol 1 216 1,374.0 1,374.0
97155 Intervention - Individual: Observation and Direction: Adaptive behavior treatment with protocol modification 4 70 381.0 95.3
97156 Family/Caregiver Training and Counseling: Individual: Family adaptive behavior treatment guidance 3 20 74.0 24.7
97157 Multiple Family Group Adaptive Behavior Treatment Guidance 0 0 0.0 0.0
99499 Unlisted Evaluation and Management Service 0 0 0.0 0.0
H0031 Administering and Reporting Standardized Measures 6 8 8.0 1.3
H0032 - CTSS Individual Treatment Plan Development and Monitoring (Children’s Therapeutic Services & Supports) 6 11 11.0 1.8
H0032 - EIDBI Individual Treatment Plan Development and Monitoring (Early Intensive Developmental and Behavioral Intervention) 4 57 57.0 14.3
H2012 Behavioral Health Day Treatment (General Day Treatment) 5 309 897.0 179.4
H2014 Skills Training 3 100 776.0 258.7
H2015 Crisis Assistance 0 0 0.0 0.0
H2019 Mental Health Behavioral Aide 0 0 0.0 0.0
T1013 Sign Language or Oral Interpreter Services 1 2 2.0 2.0
T1024 Evaluation and Treatment by Integrated, Specialty Team 1 2 2.0 2.0


Table 10b. Medica: Types of treatment provided to children with ASD by category of service (n=43)

Category of service Description Unique # of children who receive service Count of services Total units submitted Average units
054 Occupational Therapy 23 675 2,000 87.0
051 Physical Therapy 5 37 68.0 13.6
053 Speech Therapy 26 869 869.0 33.4


Table 11a. PrimeWest: Types of treatment provided to children with ASD by procedure code (n=194)

Procedure code Description Unique # of children who receive service Count of services Total units submitted Average units
90832 Psychotherapy, 30 min 10 23 23.0 2.3
90833 Psychotherapy with E&M, 30 minutes 4 10 10.0 2.5
90834 Psychotherapy, 45 min 23 132 132.0 5.7
90836 Psychotherapy with E&M, 45 min 1 1 1.0 1.0
90837 Psychotherapy, 60 min 26 204 205.0 7.9
90838 Psychotherapy with E&M, 60 min 0 0 0.0 0.0
90839 Psychotherapy for Crisis, first 60 minutes 0 0 0.0 0.0
90840 Psychotherapy for Crisis, over 74 minutes 2 2 50.0 25.0
90846 Family Psychotherapy - Without Patient Present 15 43 43.0 2.9
90847 Family Psychotherapy - With Patient Present 16 92 92.0 5.8
90849 Multiple Family Group Psychotherapy 0 0 0.0 0.0
90853 Group Psychotherapy 0 0 0.0 0.0
90887 Interpretation of Psychiatric and Other Medical Examination 3 3 3.0 1.0
90899 Unlisted Psychiatric Service 3 4 4.0 1.3
97153 EIDBI Intervention – Individual: Adaptive behavior treatment by protocol 11 2,657 20,827.0 1,893.4
97154 EIDBI Intervention – Group: Group adaptive behavior treatment by protocol 4 710 2,978.0 744.5
97155 Intervention - Individual: Observation and Direction: Adaptive behavior treatment with protocol modification 11 1,195 5,361.0 487.4
97156 Family/Caregiver Training and Counseling: Individual: Family adaptive behavior treatment guidance 9 166 888.0 98.7
97157 Multiple Family Group Adaptive Behavior Treatment Guidance 1 8 33.0 33.0
99499 Unlisted Evaluation and Management Service 0 0 0.0 0.0
H0031 Administering and Reporting Standardized Measures 18 29 29.0 1.6
H0032 - CTSS Individual Treatment Plan Development and Monitoring (Children’s Therapeutic Services & Supports) 12 20 20.0 1.7
H0032 - EIDBI Individual Treatment Plan Development and Monitoring (Early Intensive Developmental and Behavioral Intervention) 12 717 755.0 62.9
H2012 Behavioral Health Day Treatment (General Day Treatment) 1 17 50.0 50.0
H2014 Skills Training 6 36 135.0 22.5
H2015 Crisis Assistance 0 0 0.0 0.0
H2019 Mental Health Behavioral Aide 0 0 0.0 0.0
T1013 Sign Language or Oral Interpreter Services 6 15 70.0 11.7
T1024 Evaluation and Treatment by Integrated, Specialty Team 9 79 79.0 8.8


Table 11b. PrimeWest: Types of treatment provided to children with ASD by category of service (n=194)

Category of service Description Unique # of children who receive service Count of services Total units submitted Average units
054 Occupational Therapy 93 2,407 4,905 52.7
051 Physical Therapy 16 240 310.0 19.4
053 Speech Therapy 76 1,617 1,617.0 21.3


Table 12a. South Country Health Alliance: Types of treatment provided to children with ASD by procedure code (n=112)

Procedure code Description Unique # of children who receive service Count of services Total units submitted Average units
90832 Psychotherapy, 30 min 8 22 22.0 2.8
90833 Psychotherapy with E&M, 30 minutes 1 5 5.0 5.0
90834 Psychotherapy, 45 min 10 54 54.0 5.4
90836 Psychotherapy with E&M, 45 min 3 6 6.0 2.0
90837 Psychotherapy, 60 min 13 77 78.0 6.0
90838 Psychotherapy with E&M, 60 min 0 0 0.0 0.0
90839 Psychotherapy for Crisis, first 60 minutes 0 0 0.0 0.0
90840 Psychotherapy for Crisis, over 74 minutes 0 0 0.0 0.0
90846 Family Psychotherapy - Without Patient Present 12 46 46.0 3.8
90847 Family Psychotherapy - With Patient Present 10 117 117.0 11.7
90849 Multiple Family Group Psychotherapy 0 0 0.0 0.0
90853 Group Psychotherapy 0 0 0.0 0.0
90887 Interpretation of Psychiatric and Other Medical Examination 2 2 2.0 1.0
90899 Unlisted Psychiatric Service 4 8 8.0 2.0
97153 EIDBI Intervention – Individual: Adaptive behavior treatment by protocol 13 5,254 39,827.0 3,063.6
97154 EIDBI Intervention – Group: Group adaptive behavior treatment by protocol 3 10 49.0 16.3
97155 Intervention - Individual: Observation and Direction: Adaptive behavior treatment with protocol modification 13 1,561 7,594.0 584.2
97156 Family/Caregiver Training and Counseling: Individual: Family adaptive behavior treatment guidance 14 106 303.0 21.6
97157 Multiple Family Group Adaptive Behavior Treatment Guidance 4 36 118.0 29.5
99499 Unlisted Evaluation and Management Service 0 0 0.0 0.0
H0031 Administering and Reporting Standardized Measures 12 24 24.0 2.0
H0032 - CTSS Individual Treatment Plan Development and Monitoring (Children’s Therapeutic Services & Supports) 8 41 41.0 5.1
H0032 - EIDBI Individual Treatment Plan Development and Monitoring (Early Intensive Developmental and Behavioral Intervention) 16 1,071 1,089.0 68.1
H2012 Behavioral Health Day Treatment (General Day Treatment) 2 205 615.0 307.5
H2014 Skills Training 8 330 1,164.0 145.5
H2015 Crisis Assistance 0 0 0.0 0.0
H2019 Mental Health Behavioral Aide 1 2 2.0 2.0
T1013 Sign Language or Oral Interpreter Services 1 1 2.0 2.0
T1024 Evaluation and Treatment by Integrated, Specialty Team 13 245 245.0 18.8


Table 12b. South Country Health Alliance: Types of treatment provided to children with ASD by category of service (n=112)

Category of service Description Unique # of children who receive service Count of services Total units submitted Average units
054 Occupational Therapy 27 660 1,637 60.6
051 Physical Therapy 6 38 102.0 17.0
053 Speech Therapy 25 743 743.0 29.7


Table 13a. UCare: Types of treatments provided to children with ASD by procedure code (n=1,826)

Procedure code Description Unique # of children who receive service Count of services Total units submitted Average units
90832 Psychotherapy, 30 min 62 161 161.0 2.6
90833 Psychotherapy with E&M, 30 minutes 13 21 21.0 1.6
90834 Psychotherapy, 45 min 111 490 490.0 4.4
90836 Psychotherapy with E&M, 45 min 0 0 0.0 0.0
90837 Psychotherapy, 60 min 147 904 905.0 6.2
90838 Psychotherapy with E&M, 60 min 0 0 0.0 0.0
90839 Psychotherapy for Crisis, first 60 minutes 1 1 1.0 1.0
90840 Psychotherapy for Crisis, over 74 minutes 0 0 0.0 0.0
90846 Family Psychotherapy - Without Patient Present 380 1,694 1,694.0 4.5
90847 Family Psychotherapy - With Patient Present 230 739 739.0 3.2
90849 Multiple Family Group Psychotherapy 6 52 52.0 8.7
90853 Group Psychotherapy 2 3 3.0 1.5
90887 Interpretation of Psychiatric and Other Medical Examination 7 7 7.0 1.0
90899 Unlisted Psychiatric Service 46 91 206.0 4.5
97153 EIDBI Intervention – Individual: Adaptive behavior treatment by protocol 239 60,031 582,795.0 2,438.5
97154 EIDBI Intervention – Group: Group adaptive behavior treatment by protocol 92 15,462 43,779.0 475.9
97155 Intervention - Individual: Observation and Direction: Adaptive behavior treatment with protocol modification 232 19,752 131,523.0 566.9
97156 Family/Caregiver Training and Counseling: Individual: Family adaptive behavior treatment guidance 187 5,254 44,150.0 236.1
97157 Multiple Family Group Adaptive Behavior Treatment Guidance 0 0 0.0 0.0
99499 Unlisted Evaluation and Management Service 1 1 1.0 1.0
H0031 Administering and Reporting Standardized Measures 414 827 827.0 2.0
H0032 - CTSS Individual Treatment Plan Development and Monitoring (Children’s Therapeutic Services & Supports) 227 868 968.0 4.3
H0032 - EIDBI Individual Treatment Plan Development and Monitoring (Early Intensive Developmental and Behavioral Intervention) 283 11,023 11,361.0 40.1
H2012 Behavioral Health Day Treatment (General Day Treatment) 161 16,852 49,393.0 306.8
H2014 Skills Training 89 3,875 87,244.0 980.3
H2015 Crisis Assistance 7 8 12.0 1.7
H2019 Mental Health Behavioral Aide 0 0 0.0 0.0
T1013 Sign Language or Oral Interpreter Services 414 5,978 20,704.0 50.0
T1024 Evaluation and Treatment by Integrated, Specialty Team 63 313 330.0 5.2


Table 13b. UCare: Types of treatments provided to children with ASD by category of service (n=1,826)

Category of service Description Unique # of children who receive service Count of services Total units submitted Average units
054 Occupational Therapy 854 24,008 63,600 74.5
051 Physical Therapy 182 4,798 8,003.0 44.0
053 Speech Therapy 951 25,688 25,696.0 27.0


Table 14a. United Healthcare: Types of treatments provided to children with ASD by procedure code (n=115)

Procedure code Description Unique # of children who receive service Count of services Total units submitted Average units
90832 Psychotherapy, 30 min 2 6 6.0 3.0
90833 Psychotherapy with E&M, 30 minutes 0 0 0.0 0.0
90834 Psychotherapy, 45 min 5 27 27.0 5.4
90836 Psychotherapy with E&M, 45 min 0 0 0.0 0.0
90837 Psychotherapy, 60 min 3 31 31.0 10.3
90838 Psychotherapy with E&M, 60 min 0 0 0.0 0.0
90839 Psychotherapy for Crisis, first 60 minutes 0 0 0.0 0.0
90840 Psychotherapy for Crisis, over 74 minutes 0 0 0.0 0.0
90846 Family Psychotherapy - Without Patient Present 15 75 75.0 5.0
90847 Family Psychotherapy - With Patient Present 8 58 58.0 7.3
90849 Multiple Family Group Psychotherapy 0 0 0.0 0.0
90853 Group Psychotherapy 0 0 0.0 0.0
90887 Interpretation of Psychiatric and Other Medical Examination 0 0 0.0 0.0
90899 Unlisted Psychiatric Service 4 27 27.0 6.8
97153 EIDBI Intervention – Individual: Adaptive behavior treatment by protocol 9 1,861 17,797.0 1,977.4
97154 EIDBI Intervention – Group: Group adaptive behavior treatment by protocol 6 1,285 3,494.0 582.3
97155 Intervention - Individual: Observation and Direction: Adaptive behavior treatment with protocol modification 9 285 1,270.0 141.1
97156 Family/Caregiver Training and Counseling: Individual: Family adaptive behavior treatment guidance 10 71 210.0 21.0
97157 Multiple Family Group Adaptive Behavior Treatment Guidance 1 1 4.0 4.0
99499 Unlisted Evaluation and Management Service 0 0 0.0 0.0
H0031 Administering and Reporting Standardized Measures 20 37 37.0 1.9
H0032 - CTSS Individual Treatment Plan Development and Monitoring (Children’s Therapeutic Services & Supports) 6 8 8.0 1.3
H0032 - EIDBI Individual Treatment Plan Development and Monitoring (Early Intensive Developmental and Behavioral Intervention) 10 432 433.0 43.3
H2012 Behavioral Health Day Treatment (General Day Treatment) 6 306 885.0 147.5
H2014 Skills Training 3 13 40.0 13.3
H2015 Crisis Assistance 0 0 0.0 0.0
H2019 Mental Health Behavioral Aide 0 0 0.0 0.0
T1013 Sign Language or Oral Interpreter Services 14 46 187.0 13.4
T1024 Evaluation and Treatment by Integrated, Specialty Team 3 15 15.0 5.0


Table 14b. United Healthcare: Types of treatments provided to children with ASD by category of service (n=115)

Category of service Description Unique # of children who receive service Count of services Total units submitted Average units
054 Occupational Therapy 43 1,048 2,803 65.2
051 Physical Therapy 10 294 560.0 56.0
053 Speech Therapy 54 1,311 1,311.0 24.3


Notes

  • Data are limited to final version Minnesota Health Care Programs (MHCP) paid claims with service dates between Jan. 1 through Dec.31, 2023, inclusive.
  • Analysis was limited to children enrolled in a Managed Care Organization (MCO). MCO assignment was selected based on the MCO in which the recipient had the most months of enrollment during the year. If a recipient was enrolled in Fee-for-Service (FFS) for the most months during the year, then they were excluded from this analysis.
  • Only managed care claims were included in analysis.
  • Age was calculated as of December 31, 2023.
  • Analysis was limited to children aged 1 through 6.
  • Diagnostic Assessments were identified using procedure codes 97151, 90791, 90792, 90785, 96101, 96102, 96103, 96116, 96118, 96119, and 90887.
  • Children with a diagnosis of Autism Spectrum Disorder (ASD) were identified with claims having an ICD10CM diagnosis code of F84.0, F84.2, F84.3, F84.5, F84.8, or F84.9.
  • Treatments for children with a diagnosis of ASD were identified with claims having a procedure code beginning with 908 or equal to H0031, H2012, H2014, H2015, H2019, 99499 (CTSS and other mental health services); having a procedure code of T1013 or T1018 (IEP services); having a procedure code of T1024, T1027, H0032 , 99366, 97153, 97154, 97155, 97156, 97157 (EIDBI services); or having category of service of 051 (Physical Therapy), 053 (Speech Therapy), or 054 (Occupational Therapy). The service count is the sum of all the unique services for all the children in each respective MCO. These counts were deduplicated using standard DHS procedures.
  • All treatment claims were deduplicated using standard operating procedures.
  • Analysis was designed in adherence to Minnesota Statutes 256B.69, Subd. 32a. (see below).

Minn. Stat. 256B.69, subd. 32a

Initiatives to improve early screening, diagnosis, and treatment of children with autism spectrum disorder and other developmental conditions.

(a) The commissioner shall require managed care plans and county-based purchasing plans, as a condition of contract, to implement strategies that facilitate access for young children between the ages of one and three years to periodic developmental and social-emotional screenings, as recommended by the Minnesota Interagency Developmental Screening Task Force, and that those children who do not meet milestones are provided access to appropriate evaluation and assessment, including treatment recommendations, expected to improve the child's functioning, with the goal of meeting milestones by age five.

(b) The following information from encounter data provided to the commissioner shall be reported on the department's public Web site for each managed care plan and county-based purchasing plan annually by July 31 of each year beginning in 2014:

(1) the number of children who received a diagnostic assessment;

(2) the total number of children ages one to six with a diagnosis of autism spectrum disorder who received treatments;

(3) the number of children identified under clause (2) reported by each 12-month age group beginning with age one and ending with age six; and

(4) the types of treatments provided to children identified under clause (2) listed by billing code, including the number of units billed for each child.

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