Summary
MDHHS added, discontinued and re-covered several HCPCS and CPT codes in the July 2021 update to the Medicaid Provider Manual, with dates ranging from February 9, 2021 to April 16, 2021. Prior authorization was discontinued for 81510, 81511 and 81512 effective March 31, 2021, and coverage for M0239 and Q0239 was discontinued effective April 16, 2021 after the FDA revoked emergency use authorization for those codes. The update also set billing rules for MOMS claims, dental incomplete procedures, orthodontic treatment, diagnosis reporting and portable x-ray transportation.
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What to do
Action · 10 steps
01Already effective February 9, 2021: Bill M0245 and Q0245 for Physicians, Practitioners, Medical Clinics, FQHCs, RHCs and THCs for dates of service on and after that date, since MDHHS covers them under the retroactive coverage listed in the bulletin.
02Already effective February 27, 2021: Bill 91303 and 0031A for the listed provider types, including Certified Nurse Midwives, Local Health Departments, Urgent Care Centers and Child and Adolescent Health Centers, for dates of service on and after that date.
03Already effective March 31, 2021: 81510, 81511 and 81512 no longer require prior authorization, and 0098U, 0099U, 0100U, 0127U, C9068 through C9073, C9122, J7333, J7401, K1010, K1011 and K1012 are discontinued.
04Already effective April 1, 2021: Bill the new coverage codes only for the provider groups listed in the bulletin, get prior authorization for J1427 because it is marked with an asterisk, and bill 0172U for clinical laboratories.
05Already effective April 16, 2021: Stop billing M0239 and Q0239 for Medicaid because MDHHS discontinued coverage after the FDA revoked emergency use authorization for those codes.
06For MOMS claims, hold the claim until the beneficiary's MOMS ID number is available, and report Z30 as the primary diagnosis on family planning claims.
07For oral and maxillofacial surgery and anesthesiology services, report the diagnosis code in Loop 2300 HI on electronic claims, in the DDE diagnosis field, or in the Remarks section on paper claims.
08For incomplete root canal, crown or denture treatment, bill D3999, D2999 or D5899 with the PA number on the claim, using the date of service rules in the bulletin.
09For portable x-ray transportation, report the HCPCS code with the Level II modifier UN, UP, UQ, UR or US based on the number of patients served, and no transportation charge is payable unless the equipment was actually transported to the location.
10Check current applicability of these 2021 requirements before acting on them.
Codes mentioned
J1427J1554J7402J9037J934991303M0245Q0245815108151181512M0239Q0239C9068C9069C9070C9071C9072C9073C9122J7333J7401K1010K1011K1012992019920299215994929949399494G0512D2999D3999D5899Z30
Original notice
MSA 21-18
michigan.gov · Always check the source before changing claims.
Related changes
See all Michigan Medicaid - MDHHS changes →MSA 21-19MediumEffective Aug 1, 2021 · Provider BulletinMMP 23-61: Coverage of Office Based Substance Use Treatment (OBSUT) ServicesMediumEffective Jan 1, 2024 · Medical PolicyMSA 20-38MediumEffective Aug 1, 2020 · Provider BulletinMMP 26-03: Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) Code UpdatesHighEffective Jan 1, 2026 · Claims & BillingBrowse every Michigan Medicaid - MDHHS change in the policy list
Related policy hubs
Michigan Medicaid - MDHHS policiesMI policy changesAnesthesiologyDentistryOral & Maxillofacial SurgeryOB-GYNPathologyPharmacyPsychiatryRadiologyCode J1427Code J1554Code J7402Code J9037Code J9349Code 91303Code M0245Code Q0245Code 81510Code 81511Code 81512Code M0239Code Q0239Code C9068Code C9069Code C9070Code C9071Code C9072Code C9073Code C9122Code J7333Code J7401Code K1010Code K1011Code K1012Code 99201Code 99202Code 99215Code 99492Code 99493Code 99494Code G0512Code D2999Code D3999Code D5899Code Z30