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MMP 23-54: Coverage of Microprocessor Prosthetic Knee-Shin Systems and Updates to Definitive Endoskeletal Below Knee Prosthetics Add-ons
Effective date
Oct 1, 2023
Identified
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.
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What to do
Action · 4 steps
01Before 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.
02Update documentation requirements to include K-level assessments, cardiovascular/pulmonary evaluations, and manufacturer warranty information within 60 days of service.
03Add pylons to required add-on list for below knee prosthetics billing.
04Claims without proper prior authorization will be denied.
Codes mentioned
L5859L5856
Original notice
MMP 23-54: Coverage of Microprocessor Prosthetic Knee-Shin Systems and Updates to Definitive Endoskeletal Below Knee Prosthetics Add-ons
michigan.gov · Always check the source before changing claims.
Related changes
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