Who is affected by this change?

This affects Michigan Medicaid - MDHHS in MI on Medicaid plans.

When does this change take effect?

This change is effective Apr 1, 2025.

Michigan Medicaid - MDHHSMedicaid · Billing Codes · Claims & Billing · MIHigh impact

MMP 25-14: Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) Code Updates

Q: What do I need to do?

Immediately: Billing team must update Michigan Medicaid billing systems to (1) activate new HCPCS codes effective April 1, 2025 for applicable provider types, (2) add prior authorization requirements for E1161, E1231-E1238, K0005, and K0040 effective March 1, 2025, (3) stop billing discontinued codes 90476, 90584, 90644, 90759 and multiple J-codes effective March 31, 2025, and (4) verify provider type eligibility for each new code as specified in the bulletin. Update encounter forms and staff training. Claims using discontinued codes or missing required prior authorizations will be denied.

Q: Which billing codes are affected?

The following codes are affected: A9611, J0281, J1072, J1271, J1299, J1308, J1808, J1938, J2351, J2428, J2804, J2865, J9024, J9038, J9054, Q2057, Q5147, Q5149, Q5152, Q9999, A6519, E1022, E1032, E1033, E1034, L0720, 90626, 90627, A9608, G0567, G0539, G0540, L6310, L6360, L6611, L6623, L6624, L6703, L6880, L6920, L6925, L6930, L6940, L6945, L6950, L6955, L6960, L6965, L6970, L6975, L7007, L7008, L7040, L7170, L7180, L7181, L7185, L7190, L7191, L7259, E1161, E1231, E1232, E1233, E1234, E1235, E1236, E1237, E1238, K0005, K0040, 90476, 90584, 90644, 90759, A9155, G0564, G0565, J1094, J1300, J1810, J1890, J1940, J9037, J9247, L8010, Q4231, Q5139, S0017, S0028, S0032, S0039, S4988, M0220, M0221, M0222, M0223, M0240, M0241, M0243, M0244, M0247, Q0220, Q0221, Q0222, Q0240, Q0243, Q0244, Q0247, M0245, M0246, Q0245.

Act

immediately

Effective date

Apr 1, 2025

Identified

Jun 20, 2026

Summary

Michigan Medicaid has implemented multiple CPT/HCPCS code changes with various effective dates: new codes added (April 1), existing codes activated for additional provider types (April 1 and May 1), new prior authorization requirements (March 1), and discontinued codes (March 31). This affects billing for Medicaid, Healthy Michigan Plan, Children's Special Health Care Services, and MI Health Link programs.

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What to do

immediately · 3 steps

01Billing team must update Michigan Medicaid billing systems to (1) activate new HCPCS codes effective April 1, 2025 for applicable provider types, (2) add prior authorization requirements for E1161, E1231-E1238, K0005, and K0040 effective March 1, 2025, (3) stop billing discontinued codes 90476, 90584, 90644, 90759 and multiple J-codes effective March 31, 2025, and (4) verify provider type eligibility for each new code as specified in the bulletin.

02Update encounter forms and staff training.

03Claims using discontinued codes or missing required prior authorizations will be denied.

Codes mentioned

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

Original notice

MMP 25-14: Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) Code Updates

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

View original ↗

MMP 23-51: Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) Code UpdatesHighEffective Jul 1, 2023 · Claims & Billing HASA 22-03MediumEffective Jan 1, 2022 · Provider Bulletin MMP 24-58: Complex Rehabilitation Technology (CRT) EquipmentMediumEffective Jan 1, 2025 · Provider Bulletin MSA 18-17MediumEffective Jul 1, 2018 · Provider Bulletin Browse every Michigan Medicaid - MDHHS change in the policy list

Related policy hubs

Michigan Medicaid - MDHHS policies MI policy changes Code A9611 Code J0281 Code J1072 Code J1271 Code J1299 Code J1308 Code J1808 Code J1938 Code J2351 Code J2428 Code J2804 Code J2865 Code J9024 Code J9038 Code J9054 Code Q2057 Code Q5147 Code Q5149 Code Q5152 Code Q9999 Code A6519 Code E1022 Code E1032 Code E1033 Code E1034 Code L0720 Code 90626 Code 90627 Code A9608 Code G0567 Code G0539 Code G0540 Code L6310 Code L6360 Code L6611 Code L6623 Code L6624 Code L6703 Code L6880 Code L6920 Code L6925 Code L6930 Code L6940 Code L6945 Code L6950 Code L6955 Code L6960 Code L6965 Code L6970 Code L6975 Code L7007 Code L7008 Code L7040 Code L7170 Code L7180 Code L7181 Code L7185 Code L7190 Code L7191 Code L7259 Code E1161 Code E1231 Code E1232 Code E1233 Code E1234 Code E1235 Code E1236 Code E1237 Code E1238 Code K0005 Code K0040 Code 90476 Code 90584 Code 90644 Code 90759 Code A9155 Code G0564 Code G0565 Code J1094 Code J1300 Code J1810 Code J1890 Code J1940 Code J9037 Code J9247 Code L8010 Code Q4231 Code Q5139 Code S0017 Code S0028 Code S0032 Code S0039 Code S4988 Code M0220 Code M0221 Code M0222 Code M0223 Code M0240 Code M0241 Code M0243 Code M0244 Code M0247 Code Q0220 Code Q0221 Code Q0222 Code Q0240 Code Q0243 Code Q0244 Code Q0247 Code M0245 Code M0246 Code Q0245

MMP 25-14: Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) Code Updates

Summary

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What to do

Codes mentioned

Original notice

Related changes

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