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Michigan Medicaid - MDHHSMedicaid · Billing Codes · Provider Bulletin · MI · General Practice, Internal Medicine, Pediatrics +6 moreMedium impact

HASA 22-18

Effective date
Apr 1, 2022
Identified
Jun 20, 2026

Summary

For dates of service on and after April 1, 2022, Michigan Medicaid covers HCPCS codes J0219, J0491, J0879, J9071, J9273, J9359 and Q5124 for physicians, practitioners and medical clinics, and K1030, K1031, K1032 and K1033 for medical suppliers, orthotists and prosthetists, with K1030 through K1033 requiring prior authorization. Codes 0097U, 0151U, C9084, C9085, C9086, C9087 and G1009 were discontinued effective March 31, 2022, and code M1145 was discontinued effective February 27, 2022. Telemedicine codes 98966, 98967 and 98968 must not be reported with POS 02 or the GT modifier, and genetic counseling is covered when provided by a licensed Genetic Counselor and ordered by a Medicaid-enrolled physician, PA, or APRN.

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What to do

Action · 6 steps
01Already effective April 1, 2022: Billing team, bill J0219, J0491, J0879, J9071, J9273, J9359 and Q5124 for physicians, practitioners and medical clinics, and K1030, K1031, K1032 and K1033 for medical suppliers, orthotists and prosthetists.
02Get prior authorization before billing K1030, K1031, K1032 and K1033.
03Do not report 98966, 98967 or 98968 with POS 02 or the GT modifier.
04Stop reporting 0097U, 0151U, C9084, C9085, C9086, C9087 and G1009, which were discontinued effective March 31, 2022.
05For routine patient costs in a clinical trial, claims must include the National Clinical Trial (NCT) number and an ICD-10 diagnosis code indicating the services are associated with a clinical trial, such as Z00.6.
06Confirm current applicability of these 2022 requirements before acting on them.

Codes mentioned

J0219J0491J0879J9071J9273J9359Q5124K1030K1031K1032K1033V2522989669896798968989709897198972994219942299423A9595M0222Q0222M0223Q022191309S9432C9084C9085C9086C9087G1009M1145Z00.6GT

Original notice

HASA 22-18
michigan.gov · Always check the source before changing claims.
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Related changes

See all Michigan Medicaid - MDHHS changes →
MMP 23-51: Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) Code UpdatesHighEffective Jul 1, 2023 · Claims & BillingMMP 25-14: Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) Code UpdatesHighEffective Apr 1, 2025 · Claims & BillingMMP 22-33HighEffective Oct 1, 2022 · Provider BulletinMMP 23-14: Updates to the MDHHS Medicaid Provider Manual; Medicaid Eligibility Requirements; Federal Public Health EmergencyMediumEffective Apr 1, 2023 · EnrollmentBrowse every Michigan Medicaid - MDHHS change in the policy list

Related policy hubs

Michigan Medicaid - MDHHS policiesMI policy changesGeneral PracticeInternal MedicinePediatricsOB-GYNOptometryOphthalmologyGeneticsNephrologyPharmacyCode J0219Code J0491Code J0879Code J9071Code J9273Code J9359Code Q5124Code K1030Code K1031Code K1032Code K1033Code V2522Code 98966Code 98967Code 98968Code 98970Code 98971Code 98972Code 99421Code 99422Code 99423Code A9595Code M0222Code Q0222Code M0223Code Q0221Code 91309Code S9432Code C9084Code C9085Code C9086Code C9087Code G1009Code M1145Code Z00.6Code GT

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