MedicaidPrior AuthMedium impact
MMP 22-44
Michigan Medicaid - MDHHS·MI · Transplant Surgery, Cardiology, Pulmonology +6 more·Provider Bulletin
Effective date
Jan 1, 2023
We identified it
Jun 20, 2026
Summary
Michigan Medicaid has updated comprehensive coverage policies for organ and tissue transplant services, defining specific prior authorization requirements, approval durations, and documentation standards. Most organ transplants require prior authorization except kidney and cornea transplants, with detailed medical necessity criteria for each organ type.
Action Required
By January 1, 2023: Billing team must update prior authorization workflows to require PA for all organ transplants except kidney and cornea procedures. Update system to track 1-year initial authorization periods for heart, lung, liver, pancreas, bone marrow, and intestine transplants. Ensure documentation requirements including psychosocial assessments and transplant team approval letters are collected before billing. Train staff on Michigan-specific requirements including Certificate of Need facilities and OPTN membership verification.