MedicaidAdministrativeMedium impact
MMP 25-32: Independent Clinical Laboratories, Medicaid Health Plans, Integrated Care Organizations
Michigan Medicaid - MDHHS·MI · Pathology·Managed Care
Effective date
Oct 1, 2025
We identified it
Jun 20, 2026
Summary
Starting October 1, 2025, Michigan Medicaid-enrolled independent clinical laboratories can now bill for tests performed by reference laboratories under arrangement, similar to hospital laboratories. Labs must use modifier 90 and include specific reference lab information on claims.
Action Required
By October 1, 2025: Independent clinical laboratories in Michigan must update billing systems to support modifier 90 for reference lab services. Ensure claims include both referring and reference laboratory NPI, names, addresses, and CLIA numbers in appropriate claim fields (loop 2420C for electronic claims). Establish compliant contractual agreements with reference laboratories and verify CLIA certification before billing. Submit referred and non-referred tests on separate paper claims.