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Michigan Medicaid - MDHHSMedicaid · Prior Auth · Medical Policy · MI · Occupational Therapy, Physical Therapy, Speech Therapy +5 moreMedium impact

MMP 25-56: Updates to the Medicaid Provider Manual; OT/ST/PT for Beneficiaries with Autism Spectrum Disorder Clarification; Electronic Health Record (EHR) Incentive Program for Hospitals

Effective date
Jan 1, 2026
Identified
Jun 20, 2026

Summary

Already effective January 1, 2026: Occupational therapy, physical therapy and speech-language therapy are not covered when a therapy service requires prior authorization and the service rendered was not approved in the prior authorization request. Medically necessary OT, PT and ST are covered under the EPSDT benefit for Medicaid beneficiaries diagnosed with autism spectrum disorder, and beneficiaries found eligible by the PIHP for specialty Behavioral Health Treatment may have related therapy covered through the PIHP. The Electronic Health Record Incentive Program for Hospitals section is removed from the Medicaid Provider Manual, and the last eligible payment for that program was made in 2019.

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What to do

Action · 6 steps
01Already effective January 1, 2026: Therapy providers should make sure the OT, PT or ST service rendered matches the service approved in the prior authorization request, because a therapy service that requires prior authorization and was not approved in that request is not covered.
02Beneficiaries diagnosed with autism spectrum disorder should be referred to the PIHP for a comprehensive ASD assessment when further evaluation and treatment is determined necessary.
03When ASD therapy is provided under both the PIHP and the Medicaid Health Plan or Fee-for-Service program, the goals and purpose for each must be distinct, and documentation of the collaboration between therapy providers must be retained in the beneficiary's medical record for audit purposes.
04For Private Duty Nursing, the MSA-0732 must be submitted every time services are requested for an increase or decrease in services, with an updated and signed POC, and changes in condition that decrease hours must be reported to the authorizing agent as soon as they occur.
05Failure to disclose all community resources in the home on the MSA-0732 may result in a denial of authorization or may be cause for recoupment of funds.
06For comprehensive orthodontic treatment, the first MSA-1680-B must include the appropriate procedure code and the expected banding or start date of treatment.

Codes mentioned

T1999S5199T2028T2029K0739T2039E1399G0176

Original notice

MMP 25-56: Updates to the Medicaid Provider Manual; OT/ST/PT for Beneficiaries with Autism Spectrum Disorder Clarification; Electronic Health Record (EHR) Incentive Program for Hospitals
michigan.gov · Always check the source before changing claims.
View original ↗

Related changes

See all Michigan Medicaid - MDHHS changes →
MMP 26-36: Updates to the MDHHS Medicaid Provider ManualHighEffective Oct 1, 2026 · Medical PolicyMSA 17-44MediumEffective Jan 1, 2018 · Provider BulletinMSA 18-30MediumEffective Oct 1, 2018 · Provider BulletinMSA 18-45MediumEffective Jan 1, 2019 · Provider BulletinBrowse every Michigan Medicaid - MDHHS change in the policy list

Related policy hubs

Michigan Medicaid - MDHHS policiesMI policy changesOccupational TherapyPhysical TherapySpeech TherapyPediatricsPsychiatryDentistryAudiologyPharmacyCode T1999Code S5199Code T2028Code T2029Code K0739Code T2039Code E1399Code G0176

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