Summary
Effective January 1, 2018, this Michigan Medicaid bulletin updates many chapters of the Medicaid Provider Manual, including new billing rules for Medication Therapy Management services, FQHC, RHC and Tribal Health Center claims, and speech generating devices. Pharmacy-based MTM claims must use the pharmacy's Type 2 NPI as billing provider and the pharmacist's Type 1 NPI as rendering provider. Claims meeting the retroactive eligibility exception are accepted up to 12 months after the date of service, or up to six months after the retroactive eligibility determination date, whichever is later.
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What to do
Action · 11 steps
01Already effective January 1, 2018: Pharmacists document each Medication Therapy Management (MTM) service, including the beneficiary's signed and dated consent, the pharmacist NPI, the date and place of service, and the assessment of drug problems, and make that documentation available to MDHHS on request.
02Pharmacy-based MTM claims are submitted on the 837P professional format with the pharmacy's Type 2 NPI as billing provider and the pharmacist's Type 1 NPI as rendering provider, and each procedure code for telepractice carries modifier GT.
03Pharmacies may not bill in a pattern that leads to more than 13 professional dispensing fees in a 365-day billing period for the same drug entity.
04FQHC, RHC and Tribal Health Center claims must enter the Type 1 NPI of the physician overseeing the patient's care as the attending provider, which is a mandatory field, and the Type 1 NPI of the practitioner who performed the service as the rendering provider, and a Group (Type 2) NPI must not be entered as either.
05If the rendering provider field is left blank, the billing provider information is used, which may result in improper edits, claim rejection, or inaccurate settlements.
06Services within an FQHC are billed with place of service code 50, services within an RHC clinic with code 72, and services within a THC with code 07.
07Claims that meet the retroactive eligibility exception must indicate 'timely filing' in the comment section of the claim, or indicate that an MSA-1038 is on file if known.
08For speech generating devices, the speech-language pathologist initiates prior authorization for all SGD systems, eye control mechanisms, upgrades, modifications, accessories, repairs, replacements and device trials, with the MSA-1653-B request and a copy of the physician prescription.
09Providers have six months from the prior authorization approval date to provide all approved items.
10For SGD repairs, HCPCS code K0739 is reported for the labor charge and E1399 for the replacement part, and repairs with charges over $150 require an evaluation by a speech-language pathologist, occupational therapist or physical therapist.
11Check current applicability before completing any step tied to this past date.
Codes mentioned
B9000E0165K0739E1399
Original notice
MSA 17-44
michigan.gov · Always check the source before changing claims.
Related changes
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