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Michigan Medicaid - MDHHSMedicaid · Coverage · Medical Policy · MIMedium impact

MMP 23-68: Updates to the Medicaid Provider Manual; Rapid Whole Genome Sequencing Coverage Clarification

Effective date
Jan 1, 2024
Identified
Jun 20, 2026

Summary

Effective January 1, 2024, the Michigan Medicaid Provider Manual update lists technical changes and clarifications, along with a coverage clarification for rapid whole genome sequencing (rWGS). Inpatient hospitals should order rWGS only when the beneficiary is critically ill and the results will be used in the hospital management of the beneficiary, with a preliminary report generally provided in less than seven days and a final report in less than 14 days. Other revisions cover PACER authorization for admissions, readmissions, transfers and continued stays, dialysis billing aligned with Medicare, telemedicine modifiers for ACT services, and coverage standards for microprocessor knee-shin systems.

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What to do

Action · 10 steps
01Already effective January 1, 2024: Confirm current applicability of these manual rules before billing.
02Hospitals must obtain PACER authorization from the ACRC MDHHS PRD before elective admissions, all readmissions within 15 days of discharge, continued stays when appropriate, and surgical or medical transfers, and the physician or dentist must obtain the PACER number before admitting, readmitting or transferring the beneficiary.
03Do not report the PACER number on the professional claim.
04If an admission, readmission, transfer or continued stay is not approved, MDHHS does not reimburse for services rendered.
05Reconsiderations of an adverse determination must be requested within three business days.
06Psychiatric admissions and transfers to a distinct-part psychiatric unit must be authorized by the local PIHP/CMHSP.
07For ACT services, use telemedicine modifier 95 with H0039 when telemedicine is used, and use the TG modifier with H0039 for pre-admission screens.
08Prior authorization is required for all microprocessor knee-shin systems, and documentation must be less than 60 days old.
09Individual dialysis services may not be billed separately.
10Hospitals should use only laboratories whose average expected turnaround time for rWGS meets the stated timeframes.

Codes mentioned

H0039L5301L5856L5859

Original notice

MMP 23-68: Updates to the Medicaid Provider Manual; Rapid Whole Genome Sequencing Coverage Clarification
michigan.gov · Always check the source before changing claims.
View original ↗

Related changes

See all Michigan Medicaid - MDHHS changes →
MMP 23-51: Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) Code UpdatesHighEffective Jul 1, 2023 · Claims & BillingMMP 23-54: Coverage of Microprocessor Prosthetic Knee-Shin Systems and Updates to Definitive Endoskeletal Below Knee Prosthetics Add-onsMediumEffective Oct 1, 2023 · Medical PolicyMSA 18-06MediumEffective Apr 1, 2018 · Provider BulletinMSA 20-43MediumNo effective date · Provider BulletinBrowse every Michigan Medicaid - MDHHS change in the policy list

Related policy hubs

Michigan Medicaid - MDHHS policiesMI policy changesCode H0039Code L5301Code L5856Code L5859

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