MedicaidCoverageMedium impact
HASA 22-10
Michigan Medicaid - MDHHS·MI · Oncology, Cardiology, Neurology +2 more·Provider Bulletin
Effective date
Jan 1, 2022
We identified it
Jun 20, 2026
Summary
Michigan Medicaid now covers routine patient costs for beneficiaries participating in qualifying clinical trials, effective January 1, 2022. Claims must include NCT numbers, appropriate ICD-10 codes (Z00.6), and HCPCS modifiers Q0/Q1 to identify clinical trial services.
Action Required
Immediately for Michigan Medicaid patients in clinical trials: Update billing system to require NCT number entry and ICD-10 code Z00.6 for clinical trial encounters. Add HCPCS modifiers Q0 (investigational services) and Q1 (routine services) to separate line items. Train billing staff on new claim formatting requirements for institutional (condition code 30, value code D4) and professional claims (NCT number in FL 19). Set up 72-hour prior authorization tracking for clinical trial coverage determinations.