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MMP 23-14: Updates to the MDHHS Medicaid Provider Manual; Medicaid Eligibility Requirements; Federal Public Health Emergency
Effective date
Apr 1, 2023
Identified
Jun 20, 2026
Summary
Michigan Medicaid's April 2023 Medicaid Provider Manual update, effective April 1, 2023, changes NPI reporting on claims, adds doula services covered through 60 days postpartum, and sets clinical trial claim and prior authorization requirements. It also updates hearing aid dispensing and fitting services, Medicare cost-share enrollment and claim edits, and Home Help payment for a client's hospital admission date.
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What to do
Action · 8 steps
01Already effective April 1, 2023: Billing team, report the Group (Type 2 Organization) NPI and EIN in the billing provider loop on electronic claims, and report the Type 1 (Individual) NPI of the practitioner who performed the service as the rendering provider; do not enter a Type 2 NPI as the rendering provider.
02For institutional claims, report the attending provider NPI, and the attending physician must be Medicaid enrolled or the claim cannot be paid.
03Doula claims must include an ICD-10 diagnosis code and the HD modifier: bill S9445 with HD for prenatal visits (primary diagnosis Z33.1) and postpartum visits (Z39.2), up to 6 total visits per pregnancy, and bill T1033 with HD and Z33.1 for attendance at labor and delivery, 1 visit.
04Claims for routine patient costs in a clinical trial must include the National Clinical Trial (NCT) number, an ICD-10 diagnosis code indicating clinical trial services (such as Z00.6), and a completed, signed Attestation to the Appropriateness of the Qualified Clinical Trial form (BPHASA-2210); PA requests for clinical trial items must include the same attestation.
05Outpatient hospital clinical trial claims must list clinical and non-clinical trial services on separate line items, each with modifier Q0 or Q1.
06Claims for Medicaid primary services submitted by Medicare cost-share-only providers will deny, so those providers must be enrolled as Medicare Cost Share or full Medicaid providers.
07Bill hearing aid dispensing fees separately using the appropriate HCPCS code, and bill fitting and checking visits only after the 90-day dispensing fee trial period, up to two times per year without PA.
08For Home Help services on a client's hospital admission date, submit BPHASA-2207 with the service verification or within 365 days of the date of service, or MDHHS may recoup the payment.
Codes mentioned
99421994239944199443E0604A9274S9445T1033Z33.1Z39.2Z00.6
Original notice
MMP 23-14: Updates to the MDHHS Medicaid Provider Manual; Medicaid Eligibility Requirements; Federal Public Health Emergency
michigan.gov · Always check the source before changing claims.
Related changes
See all Michigan Medicaid - MDHHS changes →MMP 22-33HighEffective Oct 1, 2022 · Provider BulletinMMP 22-47MediumEffective Jan 1, 2023 · Provider BulletinMMP 24-40: Update to Medicaid Coverage of Doula ServicesMediumEffective Oct 1, 2024 · Medical PolicyHASA 22-18MediumEffective Apr 1, 2022 · Provider BulletinBrowse every Michigan Medicaid - MDHHS change in the policy list