Summary
Michigan Medicaid coverage changes in this update include new codes Q5105 and Q5106 for listed provider types effective July 1, 2018, and new code Q9994 for medical suppliers, which requires prior authorization effective October 1, 2018. Retroactive coverage of code A9274 with prior authorization took effect August 1, 2018, and several HCPCS codes were discontinued effective June 30, 2018 and December 31, 2017. The update also adds Pediatric Outpatient Intensive Feeding Program services as a Medicaid service with prior authorization requirements, and sets billing rules for State Veterans' Homes.
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What to do
Action · 8 steps
01Already effective October 1, 2018: check current applicability in the current Michigan Medicaid Provider Manual before acting on these steps.
02Medical suppliers: get prior authorization for Q9994.
03Pediatric Outpatient Intensive Feeding Program services: submit prior authorization on form MSA-6544-B with documentation of medical necessity, such as height and weight measurements and previously attempted therapeutic interventions.
04Keep a copy of the prior authorization in the beneficiary's medical record.
05To continue intensive treatment beyond the current authorization period, submit a new prior authorization with a copy of the latest re-evaluation.
06Bill the program's daily bundled rate as HCPCS S0317 on fee-for-service claims through CHAMPS, regardless of the beneficiary's health plan status.
07State Veterans' Homes: report revenue code 0022, the five-digit HIPPS code, the Assessment Reference Date, the covered days for each HIPPS code, and occurrence code 50.
08Non-routine occupational therapy, physical therapy and speech-language pathology for State Veterans' Homes must be billed on the same claims as daily care, and these providers are required to obtain prior authorization.
Codes mentioned
Q5105Q5106Q9993Q9995Q9994A9274H0010H0012H0014H0019H0020H0022H0023H0025H0032H0033H0038H0043H0045H0046H0050H2010H2014H2016H2019H2023H2035T1007T1012T1016T1027T2015T2037C946983992S0317
Original notice
MSA 18-32
michigan.gov · Always check the source before changing claims.
Related changes
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Related policy hubs
Michigan Medicaid - MDHHS policiesMI policy changesPediatricsOccupational TherapyPhysical TherapySpeech TherapyGeneral PracticeCode Q5105Code Q5106Code Q9993Code Q9995Code Q9994Code A9274Code H0010Code H0012Code H0014Code H0019Code H0020Code H0022Code H0023Code H0025Code H0032Code H0033Code H0038Code H0043Code H0045Code H0046Code H0050Code H2010Code H2014Code H2016Code H2019Code H2023Code H2035Code T1007Code T1012Code T1016Code T1027Code T2015Code T2037Code C9469Code 83992Code S0317