MedicaidCoverageMedium impact
MSA 21-54
Michigan Medicaid - MDHHS·MI · Nephrology, Emergency Medicine, Pharmacy·Provider Bulletin
Effective date
Apr 1, 2022
We identified it
Jun 20, 2026
Summary
Michigan Medicaid clarifies that dialysis services for End Stage Renal Disease (ESRD) patients eligible for Emergency Services Only (ESO) coverage are now considered emergency conditions and can be provided outside the Emergency Department. Claims must include ESRD diagnosis codes and specific emergency indicators depending on service type.
Action Required
Before April 1, 2022: Billing team must update claims processing for Michigan Medicaid ESO beneficiaries receiving dialysis services. For professional nephrology claims, include ESRD diagnosis and 'Y' Emergency Indicator. For institutional claims, report services as emergency per billing guidelines. For pharmacy claims, ensure prescriptions include appropriate ESRD diagnosis code and pharmacies report diagnosis code with level of service value '3'. Update staff training on ESRD as qualifying emergency condition for ESO coverage.