Summary
MDHHS allows primary healthcare providers in an office-based setting to be reimbursed through Medicaid fee-for-service for Alcohol Use Disorder and Opioid Use Disorder treatment, effective August 1, 2021, and this bulletin supersedes MSA 15-56. Covered services qualify when the beneficiary meets ASAM criteria for outpatient treatment and has a primary ICD-10 diagnosis of opioid or alcohol use, abuse or dependence. Providers must enroll as a fee-for-service Medicaid provider in CHAMPS, and primary healthcare providers with a specialty SUD contract with a PIHP must bill that PIHP for covered services.
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What to do
Action · 9 steps
01Already effective August 1, 2021: Billing team must confirm the practice is enrolled as a fee-for-service Medicaid provider in CHAMPS and is a valid provider type before billing AUD or OUD services through fee-for-service Medicaid.
02Bill evaluation and management, consultation, psychotherapy, collaborative care, behavioral health care management, drug testing, other laboratory, SBIRT and AUD/OUD medication services only when the beneficiary meets ASAM criteria for outpatient treatment and has a primary ICD-10 diagnosis of opioid or alcohol use, abuse or dependence.
03Primary care providers who have a specialty SUD contract with a PIHP or CMHSP must bill that PIHP or CMHSP for covered services, and for MI Health Link beneficiaries, primary healthcare providers must contract and bill the ICO or PIHP.
04Query MAPS, the Michigan Automated Prescription System, before each new prescription for AUD and OUD treatment medications, and consult MAPS regularly throughout treatment.
05Document in the clinical record the counseling decisions made with the beneficiary, prescriber, primary counselor and clinical supervisor, and make sure the treatment plan reflects those decisions.
06Evaluate the effectiveness of AUD/OUD treatment, and if services are not shown to be effective, consider approaches to enhance outcomes, including referral to the PIHP system or other treatment services.
07Make sure beneficiaries are aware of their right to file a complaint with MDHHS.
08If an individual practice reaches more than the maximum number of beneficiaries allowed under Michigan law, it must apply for an Office-Based Opioid Treatment license.
09Check current applicability of these 2021 requirements before acting on them.
Codes mentioned
992029920599211992159924199245907859079190792908329083490836908479949299494G051299484803058030780076810258658086701867068670886709868039940899409G0396G0397G2011
Original notice
MSA 21-19
michigan.gov · Always check the source before changing claims.
Related changes
See all Michigan Medicaid - MDHHS changes →MMP 23-61: Coverage of Office Based Substance Use Treatment (OBSUT) ServicesMediumEffective Jan 1, 2024 · Medical PolicyMSA 16-14MediumEffective Jul 1, 2016 · Provider BulletinMSA 20-15MediumEffective Mar 1, 2020 · Provider BulletinMSA 21-18MediumNo effective date · Provider BulletinBrowse every Michigan Medicaid - MDHHS change in the policy list
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Michigan Medicaid - MDHHS policiesMI policy changesFamily MedicineInternal MedicinePediatricsOB-GYNPsychiatryCode 99202Code 99205Code 99211Code 99215Code 99241Code 99245Code 90785Code 90791Code 90792Code 90832Code 90834Code 90836Code 90847Code 99492Code 99494Code G0512Code 99484Code 80305Code 80307Code 80076Code 81025Code 86580Code 86701Code 86706Code 86708Code 86709Code 86803Code 99408Code 99409Code G0396Code G0397Code G2011