MedicaidCoverageMedium impact
MMP 25-09: Updates to the MDHHS Medicaid Provider Manual; Psychological and Neuropsychological Evaluation Coverage Responsibility Clarification
Michigan Medicaid - MDHHS·MI · Psychiatry, Family Medicine, Pediatrics +1 more·Medical Policy
Effective date
Apr 1, 2025
We identified it
Jun 20, 2026
Summary
Michigan clarified coverage responsibility for psychological and neuropsychological evaluations effective April 1, 2025. Medicaid Health Plans cover mild to moderate conditions, while PIHPs handle severe concerns like autism and intellectual disabilities. Fee-for-service Medicaid covers screening by primary care providers.
Action Required
By April 1, 2025: Billing teams serving Michigan Medicaid patients must update workflows to verify patient's plan type (MHP vs PIHP vs FFS) before billing psychological/neuropsychological evaluations. Train staff to identify mild-moderate conditions (ADHD, anxiety, OCD) for MHP billing versus severe conditions (autism, intellectual disability) for PIHP billing. Update authorization request procedures based on condition severity and plan type.