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Michigan Medicaid - MDHHSMedicaid · Administrative · Medical Policy · MI · Pediatrics, Dentistry, Physical Therapy +3 moreMedium impact

MMP 24-30: Updates to the MDHHS Medicaid Provider Manual

Effective date
Oct 1, 2024
Identified
Jun 20, 2026

Summary

Effective October 1, 2024, MDHHS updated the Michigan Medicaid Provider Manual to incorporate earlier bulletins and clarify chapters, forms and directory contacts. The update requires prior authorization for all oral enteral formula, requires telephone authorization for specified enteral HCPCS codes, and sets prior authorization and documentation rules for children's and adolescent products such as standers, walkers, gait trainers, activity chairs, car seats, bath equipment and commodes. It also covers Electronic Visit Verification for personal care services, the dental five-year frequency verification process, and inpatient hospital drugs carved out of DRG payment.

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What to do

Action · 6 steps
01Already effective October 1, 2024: Billing team: For enteral nutrition, get prior authorization for all enteral formula for oral administration.
02The HCPCS codes B4034, B4035, B4036, B4081, B4082, B4083, B4087, B4088, B4100, B4102, B4105, B4149, B4150, B4152, B4153, B4154, B4155, B4157, B4158, B4159, B4160, B4161, B4162, B9002, B9998, E0776 and S9432 require authorization through the telephone authorization process listed in the Directory Appendix for the MDHHS Program Review Division.
03For enteral nutrition, the ordering practitioner or designated clinical staff must complete the BPHASA-2401 Medical Justification for Enteral Therapy form.
04For children's and adolescent products, PA is required for all requests, and documentation must be less than 180 days old and include a signed and dated parent or legal guardian agreement; failure to keep required documentation in the beneficiary's file may result in audit and or post payment recovery of funds.
05Fee-for-service dental crowns, complete dentures and partial dentures require verification in the CHAMPS Dental Frequency function before the service is rendered, with the service request number screenshot and the date of the response kept in the beneficiary's dental record; failure to complete verification may result in denied claims, and the provider cannot bill the beneficiary.
06For inpatient hospital drugs carved out of DRG payment, drugs without a specific HCPCS code must be submitted on a pharmacy claim, pharmacies and billing providers must ensure claims are not duplicated, and PA may be required.

Codes mentioned

B4034B4035B4036B4081B4082B4083B4087B4088B4100B4102B4105B4149B4150B4152B4153B4154B4155B4157B4158B4159B4160B4161B4162B9002B9998E0776S9432

Original notice

MMP 24-30: Updates to the MDHHS Medicaid Provider Manual
michigan.gov · Always check the source before changing claims.
View original ↗

Related changes

See all Michigan Medicaid - MDHHS changes →
MMP 23-27: End of the Federal Public Health Emergency and Unwinding of COVID-19 Response PoliciesMediumEffective May 11, 2023 · Provider BulletinMSA 19-15MediumEffective Apr 1, 2019 · Provider BulletinMSA 20-25HighEffective Mar 1, 2020 · Provider BulletinMMP 25-47: Implementation of MI Coordinated Health (MICH) ProgramMediumEffective Jan 1, 2026 · Provider BulletinBrowse every Michigan Medicaid - MDHHS change in the policy list

Related policy hubs

Michigan Medicaid - MDHHS policiesMI policy changesPediatricsDentistryPhysical TherapyOccupational TherapySpeech TherapyPharmacyCode B4034Code B4035Code B4036Code B4081Code B4082Code B4083Code B4087Code B4088Code B4100Code B4102Code B4105Code B4149Code B4150Code B4152Code B4153Code B4154Code B4155Code B4157Code B4158Code B4159Code B4160Code B4161Code B4162Code B9002Code B9998Code E0776Code S9432

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