MedicaidPrior AuthMedium impact
MSA 19-27
Michigan Medicaid - MDHHS·MI · Genetics, Oral & Maxillofacial Surgery, OB-GYN +2 more·Provider Bulletin
Effective date
Oct 1, 2019
We identified it
Jun 20, 2026
Summary
Michigan Medicaid updated genetic testing prior authorization requirements, requiring medical documentation from attending providers rather than labs, and added retroactive coverage for specific CPT codes. Fee schedules were also updated for oral maxillofacial surgeons and maternal infant health programs.
Action Required
For Michigan Medicaid providers: Update genetic testing prior authorization workflows to require medical documentation from attending providers (MD, DO, PA, NP) using form MSA-6544-B. Do not accept lab-generated forms. Include indication, clinical notes, family history, related testing, treatment plan, and lab NPI. Bill retroactive codes 87481, 87491, 87591, 87801 from May 1, 2019, and G0396, G0397, G2011 from June 1, 2019.