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MedicaidBilling CodesMedium impact

MMP 23-63: Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) Code Updates

Michigan Medicaid - MDHHS·MI·Claims & Billing
Effective date
Oct 1, 2023
We identified it
Jun 20, 2026
Days to comply

Summary

Michigan Medicaid has updated CPT and HCPCS code coverage effective October 1, 2023, adding new covered codes for various provider types and discontinuing others. The changes include new drug codes, vaccine codes, and diagnostic codes, with some requiring prior authorization.

Action Required

Action needed
Immediately: Billing team must update Michigan Medicaid billing system to include newly covered codes effective October 1, 2023. Add prior authorization requirements for codes marked with asterisk (Q2041, Q2042, Q2053, Q0478, Q0479, L5848). Stop billing discontinued codes C9151, J0800, 0066U, 0357U, 0386U, 0397U as of September 30, 2023. Verify provider type eligibility for each new code in CHAMPS system before billing.

Affected Billing Codes

J0349
J0801
J0802
J0874
J2359
J2781
J7214
J7519
J9345
90581
90584
90738
J7330
Q2041
Q2042
Q2053
90380
90381
90678
90679
96380
96381
Q0478
Q0479
82542
83520
90480
91318
91319
91320
91321
91322
M0201
91304
L5848
91312
91313
91314
91315
91316
91317
C9151
J0800