MedicaidBilling CodesHigh impact
MMP 24-62: Update to Pharmacy Benefit Coverage of Medical Injectable Physician-Administered Carve-Out Drugs
Michigan Medicaid - MDHHS·MI·Pharmacy
Effective date
Jan 1, 2025
We identified it
Jun 20, 2026
Summary
Starting January 1, 2025, Michigan Medicaid injectable drugs that were previously carved out of Medicaid Health Plan coverage will now be covered as a pharmacy benefit when billed through pharmacies. Pharmacies must submit these claims as pharmacy claims using NDC codes with Place of Service code '11' for office administration.
Action Required
By January 1, 2025: Billing team must coordinate with pharmacies to ensure injectable drug claims are submitted as pharmacy claims using NDC codes rather than medical claims. Verify pharmacies use Place of Service code '11' in NCPDP Patient Segment field 307-C7. Review current injectable drug billing processes to prevent duplicate claims between pharmacy and medical benefits. Update workflow to distinguish between direct physician procurement (continue medical billing) versus pharmacy-acquired drugs (pharmacy billing).