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Michigan Medicaid - MDHHSMedicaid · Billing Codes · Provider Bulletin · MI · General Practice, Dentistry, Podiatry +11 moreMedium impact

MSA 19-07

Effective date
Jan 1, 2019
Identified
Jun 20, 2026

Summary

Michigan Medicaid covers HCPCS Q4186 and Q4187 for physicians, nurse practitioners, podiatry, oral maxillofacial surgeons, federally qualified health centers, rural health clinics and tribal health centers, and covers J2062 for federally qualified health centers, rural health clinics and tribal health centers, for dates of service on and after January 1, 2019. HCPCS Q2041 and Q2042 require prior authorization, and HCPCS B4149 is now covered when home blenderized food does not meet the beneficiary's medical need. The same update sets the Healthy Michigan Plan changes that begin in January 2020, which require beneficiaries to report at least 80 hours per month of work or community activities, and it limits interim caries arresting medicament D1354 to one billing per date of service.

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What to do

Action · 9 steps
01Already effective January 1, 2019: Bill HCPCS Q4186 and Q4187 for the provider categories listed in the update, and bill J2062 for federally qualified health centers, rural health clinics and tribal health centers, for dates of service on and after that date.
02Obtain prior authorization before billing Q2041 and Q2042, since HCPCS Q2042 requires PA and the asterisk marks Q2041 as requiring PA.
03Bill HCPCS B4149 when home blenderized food does not meet the beneficiary's medical need.
04Bill D1354 once per date of service regardless of the number of teeth treated, up to five teeth per visit, enter the tooth number(s) or letter(s) of all teeth treated in the comments section of the claim, and note that there is a maximum of six applications per lifetime.
05Therapy claims must be submitted with the appropriate therapy modifier, and maintenance therapy visits should also include the MDHHS designated maintenance modifier, because therapy services submitted without these modifiers may be denied.
06Institutional claims for ancillary physical and occupational therapy and speech pathology need the PA number on the claim.
07Diagnostic ultrasound procedures performed more than once must be documented for medical necessity with the reason for the repeat procedure, because claims are rejected if the documentation does not support the repeat diagnostic procedure.
08Healthy Michigan Plan changes beginning in January 2020 require beneficiaries to report at least 80 hours per month of work or community activities, and providers are encouraged to keep assisting their HMP patients with healthy behavior choices and completing a health risk assessment, which can be completed online through the Provider HRA Profile in CHAMPS.
09Check current applicability before acting.

Codes mentioned

Q4186Q4187J2062Q2041Q2042B4149D1354

Original notice

MSA 19-07
michigan.gov · Always check the source before changing claims.
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Related changes

See all Michigan Medicaid - MDHHS changes →
MSA 19-01MediumEffective Jan 1, 2019 · Provider BulletinMMP 23-63: Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) Code UpdatesMediumEffective Oct 1, 2023 · Claims & BillingMSA 16-38MediumEffective Jan 1, 2017 · Provider BulletinMSA 17-08MediumNo effective date · Provider BulletinBrowse every Michigan Medicaid - MDHHS change in the policy list

Related policy hubs

Michigan Medicaid - MDHHS policiesMI policy changesGeneral PracticeDentistryPodiatryOral & Maxillofacial SurgeryPharmacyPhysical TherapyOccupational TherapySpeech TherapyPsychiatryPediatricsGeriatricsAudiologyRadiologyNuclear MedicineCode Q4186Code Q4187Code J2062Code Q2041Code Q2042Code B4149Code D1354

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