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MedicaidCoverageMedium impact

MMP 23-61: Coverage of Office Based Substance Use Treatment (OBSUT) Services

Michigan Medicaid - MDHHS·MI · Family Medicine, Internal Medicine, General Practice +1 more·Medical Policy
Effective date
Jan 1, 2024
We identified it
Jun 20, 2026
Days to comply

Summary

Michigan Medicaid will now reimburse primary healthcare providers for office-based substance use treatment services starting January 1, 2024. This expands coverage beyond specialty PIHP/CMHSP providers to include physicians, nurse practitioners, and behavioral health providers who treat substance use disorders in office settings.

Action Required

Action needed
By January 1, 2024: Providers in Michigan treating substance use disorders must ensure CHAMPS enrollment and document ASAM level of care criteria appropriateness for outpatient treatment. Update billing systems to submit covered substance use treatment codes to Medicaid FFS or MHP based on beneficiary enrollment. FQHCs, RHCs, and THCs can additionally bill H-codes. Providers with PIHP/CMHSP contracts must continue billing those entities, not Medicaid directly.

Affected Billing Codes

99202
99203
99204
99205
99211
99212
99213
99214
99215
99241
99242
99243
99244
99245
90785
90791
90792
90832
90834
90836
90847
99492
99493
99494
G0512
99484
99408
99409
G0396
G0397
G2011
H0001
H0002
H0004
H0005