Summary
Medicaid adds coverage for several HCPCS codes, with most new coverage effective July 1, 2020, A4605 for medical suppliers effective October 1, 2020, and existing codes activated for listed provider categories effective July 1, 2020. HCPCS procedure codes 0124U through 0128U, C9041, C9053, C9054, C9056, C9057, C9058, C9754, C9755 and J9199 were discontinued effective June 30, 2020. The October 2020 Medicaid Provider Manual update includes technical changes and clarifications, including prior authorization wording for home health therapy visits, and incorporates several earlier bulletins.
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What to do
Action · 11 steps
01Already effective July 1, 2020: Physicians, practitioners and medical clinics are allowed to bill J0223, J0691, J0742, J0791, J0896, J1201, J1429, J1558, J3399, J7169, J7204, J7333, J9177, J9198, J9246, J9358, Q5120 and Q5121 for dates of service on and after July 1, 2020.
02Codes marked with an asterisk require prior authorization (PA), which applies to J1429 and J3399.
03Urgent care centers may bill J0691 and J1201.
04Local health departments and child and adolescent health centers and programs may bill J0691.
05Federally qualified health centers, rural health clinics and tribal health centers may bill J0691, J0791, J1201, J7333, J9246, J9358 and Q5120.
06Existing HCPCS codes are activated for coverage for physicians, practitioners, medical clinics and the other listed provider categories.
07Codes covered differently than Medicare, or specific to Michigan Medicaid services, for OPPS/APC and ASC are identified on the July 2020 OPPS and ASC Wrap-Around Code List on the MDHHS website.
08Already effective February 3, 2020: Physicians, practitioners and medical clinics are covered for Q5119 for dates of service on and after February 3, 2020.
09Already effective October 1, 2020: Medical suppliers are allowed to bill A4605 for dates of service on and after October 1, 2020.
10Already effective June 30, 2020: The HCPCS procedure codes 0124U, 0125U, 0126U, 0127U, 0128U, C9041, C9053, C9054, C9056, C9057, C9058, C9754, C9755 and J9199 were discontinued for all applicable provider types.
11Check current applicability in the MDHHS Medicaid Provider Manual on the MDHHS website.
Codes mentioned
J0223J0691J0742J0791J0896J1201J1429J1558J3399J7169J7204J7333J9177J9198J9246J9358Q5120Q5121A4605Q5119C9041C9053C9054C9056C9057C9058C9754C9755J9199
Original notice
MSA 20-59
michigan.gov · Always check the source before changing claims.
Related changes
See all Michigan Medicaid - MDHHS changes →MSA 21-18MediumNo effective date · Provider BulletinMMP 26-31: Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) Code UpdatesHighEffective Jul 1, 2026 · Claims & BillingMSA 17-01MediumEffective Jan 1, 2017 · Provider BulletinMSA 17-30MediumEffective Jul 1, 2017 · Provider BulletinBrowse every Michigan Medicaid - MDHHS change in the policy list
Related policy hubs
Michigan Medicaid - MDHHS policiesMI policy changesCode J0223Code J0691Code J0742Code J0791Code J0896Code J1201Code J1429Code J1558Code J3399Code J7169Code J7204Code J7333Code J9177Code J9198Code J9246Code J9358Code Q5120Code Q5121Code A4605Code Q5119Code C9041Code C9053Code C9054Code C9056Code C9057Code C9058Code C9754Code C9755Code J9199