Summary
Effective May 9, 2016, Michigan Medicaid covers Targeted Case Management (TCM) for pregnant women and children who were served by the Flint water system during the specified time period and meet Medicaid eligibility requirements. Face-to-face assessment visits are billed with T2024 at $201.58 for an individual or family, and face-to-face follow-up and monitoring visits are billed with T1017 at $201.58. A maximum of six face-to-face visits per year is reimbursed per eligible beneficiary: one initial or annual comprehensive assessment and up to five monitoring visits, and additional visits require prior authorization.
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What to do
Action · 10 steps
01Already effective May 9, 2016: Verify beneficiary eligibility for TCM services through CHAMPS or a HIPAA 270/271 transaction.
02The response must show a current MAGI category beginning with "F" and a current benefit plan of "TCMF" in addition to the assigned Medicaid or CHIP benefit plans.
03Bill the face-to-face initial or annual assessment visit with T2024 at $201.58 for an individual or family, and bill T2024 with modifier TT at $100 for each additional individual Plan of Care developed from the same assessment visit.
04Assessment visits must be in the home or home-like environment.
05Bill each face-to-face follow-up or monitoring visit with T1017 at $201.58, and make sure it lasts at least 30 minutes.
06For follow-up visits, enter the beneficiary ID numbers of the family members served in the claim notes.
07Obtain prior authorization before rendering any assessment visit beyond one per year per family or household, or any follow-up visit beyond five per year per beneficiary.
08Submit claims through CHAMPS on the ASC X12N 837 5010 professional format, or on the CMS 1500 claim form for paper claims.
09Missed appointments are not reimbursed, and the beneficiary may not be billed for them.
10TCM services are discontinued if CMS does not extend the Flint, Michigan Section 1115 Demonstration Waiver, so check current applicability before billing.
Codes mentioned
T2024T1017
Original notice
MSA 16-10
michigan.gov · Always check the source before changing claims.
Related changes
See all Michigan Medicaid - MDHHS changes →MSA 16-26MediumEffective Oct 1, 2016 · Provider BulletinMMP 23-20: COVID-19 Response: Reversal of Temporary COVID-19 Relaxation of Face-to-Face Requirement Policies and Update to Face-to-Face and In Person DefinitionsMediumEffective May 12, 2023 · Provider BulletinMMP 23-38: Updates to the MDHHS Medicaid Provider ManualMediumEffective Jul 1, 2023 · Medical PolicyBrowse every Michigan Medicaid - MDHHS change in the policy list