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Michigan Medicaid - MDHHSMedicaid · Billing Codes · Provider Bulletin · MIMedium impact

MSA 18-01

Effective date
Not stated in the notice
Identified
Jun 20, 2026

Summary

Michigan Medicaid updated coverage for CPT and HCPCS codes for physicians, clinics and other providers, with different dates for each topic. Prior authorization was required for listed codes for dates of service on and after September 1, 2017 (V5030, V5040, V5120) and January 1, 2018 (36475, 36476, 36478, 36479, 81222, 81223, 81228, 81229, 81242, 81315, 81316, 81332, 88235). Codes discontinued effective December 31, 2017 were removed, and D1354 required tooth numbers in the claim comments from January 1, 2018.

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What to do

Action · 5 steps
01Already effective September 1, 2017 and January 1, 2018 ; check current applicability rather than completing these past dates): Billing team should get prior authorization before billing V5030, V5040 and V5120 for dates of service on or after September 1, 2017, and before billing the codes 36475, 36476, 36478, 36479, 81222, 81223, 81228, 81229, 81242, 81315, 81316, 81332 and 88235 for dates of service on or after January 1, 2018.
02Billing team should stop billing the codes discontinued effective December 31, 2017 that are listed in section G of the notice.
03For D1354, bill once per date of service for no more than 5 teeth per visit, and enter the tooth number or letter of every tooth treated in the claim comments, effective January 1, 2018.
04For R0075, report the Level II modifier UN, UP, UQ, UR or US for the number of patients served per trip, effective for dates of service in January 2018.
05Medicaid covers 99408 and 99409 for dates of service on and after July 1, 2017.

Codes mentioned

V5030V5040V512036475364763647836479812228122381228812298124281315813168133288235D13549940899409R0070R0075

Original notice

MSA 18-01
michigan.gov · Always check the source before changing claims.
View original ↗

Related changes

See all Michigan Medicaid - MDHHS changes →
MSA 18-16MediumEffective Jul 1, 2018 · Provider BulletinMMP 26-40: Portable X-ray Suppliers Rate UpdateHighEffective Oct 1, 2026 · Claims & BillingMSA 16-14MediumEffective Jul 1, 2016 · Provider BulletinMSA 19-19MediumEffective Sep 1, 2019 · Provider BulletinBrowse every Michigan Medicaid - MDHHS change in the policy list

Related policy hubs

Michigan Medicaid - MDHHS policiesMI policy changesCode V5030Code V5040Code V5120Code 36475Code 36476Code 36478Code 36479Code 81222Code 81223Code 81228Code 81229Code 81242Code 81315Code 81316Code 81332Code 88235Code D1354Code 99408Code 99409Code R0070Code R0075

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