MedicaidPrior AuthMedium impact
MMP 23-54: Coverage of Microprocessor Prosthetic Knee-Shin Systems and Updates to Definitive Endoskeletal Below Knee Prosthetics Add-ons
Michigan Medicaid - MDHHS·MI · Orthopedics, PM&R (Physical Medicine & Rehab), Physical Therapy·Medical Policy
Effective date
Oct 1, 2023
We identified it
Jun 20, 2026
Summary
Michigan Medicaid now covers microprocessor prosthetic knee-shin systems with prior authorization for qualified amputee beneficiaries meeting specific functional and physical criteria. Additionally, pylons are now required add-ons for below knee prosthetics, and liner terminology has been updated to include all liner types.
Action Required
Before October 1, 2023: Billing team must update prior authorization workflows to require PA for all microprocessor knee-shin systems (L5856, L5859) for Michigan Medicaid beneficiaries. Update documentation requirements to include K-level assessments, cardiovascular/pulmonary evaluations, and manufacturer warranty information within 60 days of service. Add pylons to required add-on list for below knee prosthetics billing. Claims without proper prior authorization will be denied.