Summary
Effective January 1, 2020, MDHHS adopts the 2020 HCPCS codes listed for dates of service on and after that date, and any new procedure code not listed will not be covered at this time, except for reporting codes. MDHHS discontinued prior authorization for V5171, V5181, V5211 and V5221 effective August 31, 2019, and for J0570, Q9991 and Q9992 effective December 1, 2019. MDHHS discontinued coverage of 58565 and A4264 for services provided after December 31, 2019.
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What to do
Action · 7 steps
01Already effective January 1, 2020: Billing team should bill the 2020 HCPCS codes only for the provider categories listed in the bulletin, because codes not listed will not be covered at this time except reporting codes.
02Stop requesting prior authorization for V5171, V5181, V5211 and V5221 (discontinued August 31, 2019) and for J0570, Q9991 and Q9992 (discontinued December 1, 2019).
03Do not bill 58565 or A4264 for services provided after December 31, 2019.
04Claims for D1354, D2799, D6081 and D6253 require tooth number(s), claims for D2940 require a tooth surface, and claims for D7260, D7261, D7510 and D8692 require the oral cavity.
05Already effective November 1, 2019: Zolgensma, reported under HCPCS code J3490, was added as a Medicaid Health Plan carve-out.
06Claims for always therapy services must include the appropriate therapy modifier (GN, GP or GO) and be provided under a therapy plan of care.
07Medicaid modifier U6 is required for all drugs purchased through the 340B program.
Codes mentioned
A5514L803281252812538125481538L8625Q009266982D1354D2799D6081D6253D2940D7260D7261D7510D869258565A4264J3490V5171V5181V5211V5221J0570Q9991Q9992
Original notice
MSA 20-01
michigan.gov · Always check the source before changing claims.
Related changes
See all Michigan Medicaid - MDHHS changes →Related policy hubs
Michigan Medicaid - MDHHS policiesMI policy changesCode A5514Code L8032Code 81252Code 81253Code 81254Code 81538Code L8625Code Q0092Code 66982Code D1354Code D2799Code D6081Code D6253Code D2940Code D7260Code D7261Code D7510Code D8692Code 58565Code A4264Code J3490Code V5171Code V5181Code V5211Code V5221Code J0570Code Q9991Code Q9992