MedicaidBilling CodesHigh impact
MMP 23-67: Skilled Maintenance Therapy
Michigan Medicaid - MDHHS·MI · Physical Therapy, Occupational Therapy, Speech Therapy·Provider Bulletin
Effective date
Jan 1, 2024
We identified it
Jun 20, 2026
Summary
Starting January 1, 2024, Michigan Medicaid eliminates the requirement to bill skilled maintenance therapy under re-evaluation codes and allows billing under specific therapeutic procedure codes instead. Providers must use the TS modifier to identify maintenance therapy services and can provide up to 4 sessions per treatment period without prior authorization.
Action Required
By January 1, 2024: Billing team must update system to allow skilled maintenance therapy billing under therapeutic procedure codes (97110, 97112, 97116, 97129, 97130, 97140, 97530, 97533, 97535, 97542, 97763, 92526, 92507, 92609) instead of re-evaluation codes. Configure system to require TS modifier for all maintenance therapy claims plus appropriate discipline modifiers (GP, GO, or GN). Add modifier 96 for habilitative services. Set limits of 4 sessions or 16 units per treatment period without prior authorization (90 days outpatient, 60 days nursing facility/home health). Claims without TS modifier will be processed as restorative therapy with different benefit limits.