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Michigan Medicaid - MDHHSMedicaid · Prior Auth · Provider Bulletin · MI · Audiology, Dentistry, Genetics +6 moreMedium impact

MSA 18-45

Effective date
Jan 1, 2019
Identified
Jun 20, 2026

Summary

MDHHS completed its January 2019 quarterly update to the Michigan Medicaid Provider Manual, with changes effective January 1, 2019. After the initial 90 days, home health aide services may be provided up to a maximum of 36 visits within 90 consecutive calendar days, and requests that extend beyond 36 visits are reviewed for medical appropriateness. Outpatient physical and occupational therapy in a private practice or outpatient hospital setting is limited to 144 units (15-minute increments) in a consecutive 12-month calendar year without prior authorization, and speech therapy is limited to 36 visits. Face-to-face visits are required before the initial written order for specified durable medical equipment and supplies, and the KX modifier must be appended to those HCPCS codes when the documentation is on file.

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What to do

Action · 8 steps
01Already effective January 1, 2019: Check current MDHHS rules before applying these requirements, because this update is .
02Billing team: For home health aide services beyond the initial 90 days, the home health agency must submit a new MSA-181 with updated documentation, and the request must be received by the Program Review Division no less than 15 business days before the end of the current authorization period.
03Include the PA number on every home health claim and in all communications to the Program Review Division.
04Verify beneficiary eligibility monthly at a minimum, because approval of the MSA-181 does not guarantee Medicaid eligibility on the date of service.
05Facilities billing ancillary therapy must bill each service on a separate claim line with the date of service, a revenue code and HCPCS code, the PA number, and the therapy discipline and nature modifier.
06Professional therapy claims must use the procedure code and the therapy modifier for the discipline (GO occupational, GP physical, GN speech) and the habilitative (96) or rehabilitative (97) modifier, with TS added to maintenance visits, and therapy services submitted without these modifiers may be denied.
07For items that require a face-to-face visit, the ordering physician must certify that the visit occurred within six months before the written order and must document the required details, and the face-to-face documentation must be kept in the beneficiary file.
08Append the KX modifier only when the face-to-face documentation has been received and is on file, because adding it without documentation is incorrect billing that could result in post-payment recovery of funds or provider audit.

Codes mentioned

A4253A4259K0739

Original notice

MSA 18-45
michigan.gov · Always check the source before changing claims.
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Related changes

See all Michigan Medicaid - MDHHS changes →
MSA 19-04MediumEffective Apr 1, 2019 · Provider BulletinMSA 19-27MediumNo effective date · Provider BulletinMMP 23-27: End of the Federal Public Health Emergency and Unwinding of COVID-19 Response PoliciesMediumEffective May 11, 2023 · Provider BulletinMMP 23-31: Revisions to Continuous Glucose Monitoring Systems (CGMS) PolicyMediumEffective Jun 1, 2023 · Medical PolicyBrowse every Michigan Medicaid - MDHHS change in the policy list

Related policy hubs

Michigan Medicaid - MDHHS policiesMI policy changesAudiologyDentistryGeneticsOB-GYNOccupational TherapyPhysical TherapySpeech TherapyPsychiatryPediatricsCode A4253Code A4259Code K0739

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