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Michigan Medicaid - MDHHSMedicaid · Prior Auth · Provider Bulletin · MI · Audiology, ENT (Ear, Nose & Throat)Medium impact

MSA 20-11

Effective date
Jul 1, 2020
Identified
Jun 20, 2026

Summary

This historical 2020 Michigan Medicaid change is effective for services provided on and after July 1, 2020, and it removes prior authorization for several fee-for-service hearing items. Prior authorization no longer applies to contralateral routing devices (CROS/BICROS) on the MDHHS Volume Purchase Contract, to MDHHS Volume Purchase Contract hearing aids prescribed for unilateral hearing loss, or to unilateral implantable and non-implantable bone anchored hearing devices (BAHDs). Cochlear implant coverage was expanded to include bilateral implantation for beneficiaries 20 years of age and over who meet the listed standards, and prior authorization is still required for those implants.

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What to do

Action · 8 steps
01Already effective July 1, 2020: Billing team: for CROS/BICROS devices on the MDHHS Volume Purchase Contract and for contract hearing aids prescribed for unilateral hearing loss, PA is no longer required when the other hearing aid requirements are met, and the same applies to unilateral implantable and non-implantable BAHDs.
02Billing team: for auditory rehabilitation, PA is required for visits beyond 36 visits per calendar year.
03Billing team: for cochlear implant mapping, one initial session per implant after surgery and up to five subsequent sessions per implant are covered, and PA is required for additional sessions.
04Billing team: report the LT or RT modifier on earmolds, sound processors, devices, and monaural dispensing services, using two claim lines when the same service is provided for both ears on the same date of service.
05Billing team: after PA is issued, make sure the PA number, HCPCS or CPT code, modifier, and quantity on the claim match the approved PA.
06Providers: submit PA on form MSA-1653-B by mail or fax, or electronically through FFS Direct Data Entry in CHAMPS with the form attached, and keep the PA determination letter in the medical record.
07Services provided before PA is requested will not be covered.
08Keep applicable documentation in the beneficiary file for seven years.

Codes mentioned

9263092633V5266L8615L8616L8617L8618L8619L8621L8622L8623L8624L8625L8627L8628L8629L8692L8694

Original notice

MSA 20-11
michigan.gov · Always check the source before changing claims.
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Related changes

See all Michigan Medicaid - MDHHS changes →
MSA 20-22HighEffective Mar 1, 2020 · Provider BulletinMSA 20-53MediumEffective Jun 1, 2020 · Provider BulletinMMP 24-39: Medicaid Program Rate Updates Fiscal Year (FY) 2025; Federally Qualified Health Center (FQHC) Reimbursement UpdateHighEffective Oct 1, 2024 · Claims & BillingMSA 18-46HighEffective Jan 1, 2019 · Provider BulletinBrowse every Michigan Medicaid - MDHHS change in the policy list

Related policy hubs

Michigan Medicaid - MDHHS policiesMI policy changesAudiologyENT (Ear, Nose & Throat)Code 92630Code 92633Code V5266Code L8615Code L8616Code L8617Code L8618Code L8619Code L8621Code L8622Code L8623Code L8624Code L8625Code L8627Code L8628Code L8629Code L8692Code L8694

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