When does this change take effect?

This change is effective Oct 1, 2025.

What do I need to do?

Already effective October 1, 2025: Check current applicability before acting on these changes. Dialysis: nonroutine additional services must be billed using the appropriate supporting HCPCS code, and laboratory services included in the composite rate should be billed to the dialysis facility when an outside laboratory performs them. Dialysis services provided to an Emergency Services Only beneficiary must include a diagnosis code for End Stage Renal Disease on Dialysis, and professional services for emergency dialysis must include an ESRD diagnosis and the 'Y' Emergency Indicator. Therapy: documentation for each service date must include the total treatment minutes of all timed procedure codes and the total active treatment minutes, and documentation must be retained for seven years. Recuperative care: prior authorization for room and board (S9976) must be obtained from PRD, and for MHP or MHL beneficiaries the MHP or Integrated Care Organization must be contacted for prior authorization for care coordination (G9002). Care coordination (G9002) for MHP or MHL enrollees is billed to the MHP or ICO, and for FFS beneficiaries it is billed through CHAMPS as an FFS claim. Emergency ambulance claims must be coded with both an emergency procedure code and an appropriate ICD diagnosis code when the transport goes to a hospital, and claims without this information will be rejected. Secondary claims for Medicare/Medicaid dually eligible beneficiaries for dental services must include the KX modifier and an ICD-10 diagnosis. Home Help services provided outside the client's home must be logged in HHAeXchange or an alternative EVV system. Eligible high-cost physician-administered drugs billed through the pharmacy benefit require the prescribing practitioner to submit a prior authorization request, and the prescriber must provide proof of prior authorization approval and the prescription to the pharmacy. Effective March 7, 2024, medication aide training and registration fees are an allowable support cost on the nursing facility cost report, and travel costs for training are not allowable.

Which billing codes are affected?

The following codes are affected: 90935, 90937, 90945, 90947, S9976, G9002, T1040.

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Michigan Medicaid - MDHHSMedicaid · Administrative · Medical Policy · MI · Nephrology, Family Medicine, Psychiatry +7 moreMedium impact

MMP 25-40: Updates to the MDHHS Medicaid Provider Manual; Behavioral and Physical Health and Aging Services Administration (BPHASA) Reorganized and Renamed Health Services

Q: Who is affected by this change?

This affects Michigan Medicaid - MDHHS Nephrology, Family Medicine, Psychiatry, Pharmacy, Physical Therapy, Occupational Therapy +4 more providers in MI on Medicaid, Traditional Medicare plans.

Effective date

Oct 1, 2025

Identified

Jun 20, 2026

Summary

The October 2025 update to the MDHHS Medicaid Provider Manual renames the Behavioral and Physical Health and Aging Services Administration (BPHASA) to Health Services throughout the manual and incorporates bulletins MMP 25-10 through MMP 25-25. Its dialysis changes state that hemodialysis codes such as 90935 and 90937 describe the procedure with all related E/M services on the day of the procedure, and that dialysis codes such as 90945 and 90947 cover other dialysis procedures. Other billing changes cover timed therapy minutes, recuperative care prior authorization, emergency ambulance claim coding, dental secondary claims for dually eligible beneficiaries, and electronic visit verification for Home Help services.

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What to do

Action · 11 steps

01Already effective October 1, 2025: Check current applicability before acting on these changes.

02Dialysis: nonroutine additional services must be billed using the appropriate supporting HCPCS code, and laboratory services included in the composite rate should be billed to the dialysis facility when an outside laboratory performs them.

03Dialysis services provided to an Emergency Services Only beneficiary must include a diagnosis code for End Stage Renal Disease on Dialysis, and professional services for emergency dialysis must include an ESRD diagnosis and the 'Y' Emergency Indicator.

04Therapy: documentation for each service date must include the total treatment minutes of all timed procedure codes and the total active treatment minutes, and documentation must be retained for seven years.

05Recuperative care: prior authorization for room and board (S9976) must be obtained from PRD, and for MHP or MHL beneficiaries the MHP or Integrated Care Organization must be contacted for prior authorization for care coordination (G9002).

06Care coordination (G9002) for MHP or MHL enrollees is billed to the MHP or ICO, and for FFS beneficiaries it is billed through CHAMPS as an FFS claim.

07Emergency ambulance claims must be coded with both an emergency procedure code and an appropriate ICD diagnosis code when the transport goes to a hospital, and claims without this information will be rejected.

08Secondary claims for Medicare/Medicaid dually eligible beneficiaries for dental services must include the KX modifier and an ICD-10 diagnosis.

09Home Help services provided outside the client's home must be logged in HHAeXchange or an alternative EVV system.

10Eligible high-cost physician-administered drugs billed through the pharmacy benefit require the prescribing practitioner to submit a prior authorization request, and the prescriber must provide proof of prior authorization approval and the prescription to the pharmacy.

11Effective March 7, 2024, medication aide training and registration fees are an allowable support cost on the nursing facility cost report, and travel costs for training are not allowable.

Codes mentioned

90935909379094590947S9976G9002T1040

Original notice

MMP 25-40: Updates to the MDHHS Medicaid Provider Manual; Behavioral and Physical Health and Aging Services Administration (BPHASA) Reorganized and Renamed Health Services

michigan.gov · Always check the source before changing claims.

View original ↗

MMP 26-36: Updates to the MDHHS Medicaid Provider ManualHighEffective Oct 1, 2026 · Medical Policy MMP 24-27: Targeted Case Management - Recuperative CareMediumEffective Sep 1, 2024 · Provider Bulletin MMP 26-29: Certified Community Behavioral Health Clinic (CCBHC) Demonstration Direct Payment TransitionMediumEffective Oct 1, 2025 · Claims & Billing MSA 21-34MediumEffective Oct 1, 2021 · Provider Bulletin Browse every Michigan Medicaid - MDHHS change in the policy list

Related policy hubs

Michigan Medicaid - MDHHS policies MI policy changes Nephrology Family Medicine Psychiatry Pharmacy Physical Therapy Occupational Therapy Speech Therapy Geriatrics Emergency Medicine Pediatrics Code 90935 Code 90937 Code 90945 Code 90947 Code S9976 Code G9002 Code T1040

MMP 25-40: Updates to the MDHHS Medicaid Provider Manual; Behavioral and Physical Health and Aging Services Administration (BPHASA) Reorganized and Renamed Health Services

Summary

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What to do

Codes mentioned

Original notice

Related changes

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