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Michigan Medicaid - MDHHSMedicaid · Billing Codes · Provider Bulletin · MI · Physical Therapy, Occupational Therapy, Speech TherapyHigh impact

MMP 23-67: Skilled Maintenance Therapy

Act
by Jan 1, 2024
Effective date
Jan 1, 2024
Identified
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.

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What to do

by Jan 1, 2024 · 5 steps
01Billing 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.
02Configure system to require TS modifier for all maintenance therapy claims plus appropriate discipline modifiers (GP, GO, or GN).
03Add modifier 96 for habilitative services.
04Set limits of 4 sessions or 16 units per treatment period without prior authorization (90 days outpatient, 60 days nursing facility/home health).
05Claims without TS modifier will be processed as restorative therapy with different benefit limits.

Codes mentioned

9711097112971169712997130971409753097533975359754297763925269250792609

Original notice

MMP 23-67: Skilled Maintenance Therapy
michigan.gov · Always check the source before changing claims.
View original ↗

Related changes

See all Michigan Medicaid - MDHHS changes →
MSA 20-22HighEffective Mar 1, 2020 · Provider BulletinMMP 24-39: Medicaid Program Rate Updates Fiscal Year (FY) 2025; Federally Qualified Health Center (FQHC) Reimbursement UpdateHighEffective Oct 1, 2024 · Claims & BillingMSA 18-29MediumEffective Oct 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 changesPhysical TherapyOccupational TherapySpeech TherapyCode 97110Code 97112Code 97116Code 97129Code 97130Code 97140Code 97530Code 97533Code 97535Code 97542Code 97763Code 92526Code 92507Code 92609

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