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Michigan Medicaid - MDHHSMedicaid · Coverage · Medical Policy · MI · Physical Therapy, Occupational Therapy, Speech Therapy +7 moreMedium impact

MMP 23-38: Updates to the MDHHS Medicaid Provider Manual

Effective date
Jul 1, 2023
Identified
Jun 20, 2026

Summary

MDHHS bulletin MMP 23-38 (issued June 1, 2023) announces the July 2023 update of the Michigan Medicaid Provider Manual, available July 1, 2023, and applies to Medicaid, Healthy Michigan Plan, Children's Special Health Care Services, Children's Waiver, Maternity Outpatient Medical Services and MI Choice Waiver. Technical changes include therapy billing rules: every therapy service needs a therapy modifier (GN, GO or GP), habilitative therapy is billed with modifier 96, and maintenance therapy also uses modifier TS. Therapy services submitted without these modifiers may be denied. The bulletin also incorporates earlier bulletins covering telemedicine, home health, dental, genetic and molecular testing, in-person assessment requirements, and Private Duty Nursing prior authorization on form MSA-0732.

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What to do

Action · 11 steps
01Already effective July 1, 2023; check current applicability.
02Billing team: for Medicaid therapy claims, report an appropriate therapy modifier (GN, GO or GP) on every therapy service line, add modifier 96 for habilitative therapy, and add modifier TS for maintenance therapy, because therapy submitted without these modifiers may be denied.
03For co-treatment, the combined units billed by both therapists must not exceed the total time the beneficiary received co-treatment, both therapists may not bill the same minutes, and medical record documentation must substantiate the treatment time billed by each discipline.
04For dental crowns, complete dentures, immediate complete dentures and partial dentures, verify the five-year rule with MDHHS before rendering service and keep the service request number and response date in the dental record, since failure to complete verification may result in claim denial.
05Prior authorization is required for complete dentures, partial dentures, immediate complete dentures and periodontal scaling and root planing, and the dental PA request goes on form MSA-1680-B.
06For genetic and molecular tests, the test must be ordered by a Medicaid-enrolled physician, physician assistant or advanced practice registered nurse and performed at a Medicaid-enrolled, CLIA-certified laboratory.
07For ACT telepractice, use modifier 95 with encounter code H0039.
08For MIHP telehealth, document the beneficiary consent and the reason for any telephone-only visit.
09For Family Supports Coordination assessment visits, bill HCPCS T2024, with modifier TT for each additional individual Plan of Care.
10For Private Duty Nursing, submit form MSA-0732 before services begin and at regular intervals thereafter if continued services are needed.
11Read the full bulletin at the source link for the other manual changes.

Codes mentioned

GNGOGP9697TSH0039T2024TT

Original notice

MMP 23-38: Updates to the MDHHS Medicaid Provider Manual
michigan.gov · Always check the source before changing claims.
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Related changes

See all Michigan Medicaid - MDHHS changes →
HASA 22-03MediumEffective Jan 1, 2022 · Provider BulletinMSA 16-10MediumEffective May 9, 2016 · Provider BulletinMSA 16-26MediumEffective Oct 1, 2016 · Provider BulletinMSA 18-06MediumEffective Apr 1, 2018 · Provider BulletinBrowse every Michigan Medicaid - MDHHS change in the policy list

Related policy hubs

Michigan Medicaid - MDHHS policiesMI policy changesPhysical TherapyOccupational TherapySpeech TherapyDentistryGeneticsPsychiatryPharmacyPediatricsOB-GYNGeriatricsCode GNCode GOCode GPCode 96Code 97Code TSCode H0039Code T2024Code TT

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