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MMP 23-61: Coverage of Office Based Substance Use Treatment (OBSUT) Services
Effective date
Jan 1, 2024
Identified
Jun 20, 2026
Summary
Effective January 1, 2024, primary healthcare providers in an office-based setting are reimbursed for substance use treatment services through Medicaid fee-for-service or the Medicaid Health Plan, depending on the beneficiary's program enrollment. Covered services include evaluation and management, psychotherapy, psychiatric collaborative care management, SBIRT and medications for substance use treatment when the beneficiary meets ASAM level of care criteria for outpatient treatment and has a primary substance use disorder diagnosis. This policy supersedes MSA 13-13 and MSA 21-19.
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What to do
Action · 8 steps
01Already effective January 1, 2024: Primary healthcare providers must document beneficiary appropriateness for outpatient treatment, and if a beneficiary exceeds appropriateness for outpatient treatment, the provider must refer them to specialty services.
02Query the Michigan Automated Prescription System (MAPS) before each new prescription for substance use treatment medications, and consult MAPS regularly throughout the beneficiary's course of treatment.
03Providers with a specialty SUD services contract with a PIHP or CMHSP must bill those entities for covered services.
04For MI Health Link beneficiaries, primary healthcare providers must contract with and bill the Integrated Care Organization (ICO) or PIHP.
05For beneficiaries enrolled in a Medicaid Health Plan, these services are reimbursed through the MHP.
06Counseling decisions should be documented in the clinical record, and the treatment plan should reflect those decisions.
07If an individual practice reaches more than the maximum number of beneficiaries receiving services per Michigan Law, it must apply for an Office-Based Opioid Treatment (OBOT) license.
08Check current applicability before relying on this guidance.
Codes mentioned
992029920599211992159924199245907859079190792908329083490836908479949299494G0512994849940899409G0396G0397G2011H0001H0002H0004H0005
Original notice
MMP 23-61: Coverage of Office Based Substance Use Treatment (OBSUT) Services
michigan.gov · Always check the source before changing claims.
Related changes
See all Michigan Medicaid - MDHHS changes →MSA 21-19MediumEffective Aug 1, 2021 · Provider BulletinMSA 16-14MediumEffective Jul 1, 2016 · Provider BulletinMSA 20-15MediumEffective Mar 1, 2020 · Provider BulletinMMP 23-10: Telemedicine Policy Post-COVID-19 Public Health EmergencyMediumEffective May 12, 2023 · TelehealthBrowse every Michigan Medicaid - MDHHS change in the policy list
Related policy hubs
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