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MMP 26-31: Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) Code Updates

Michigan Medicaid - MDHHS·MI·Claims & Billing
Effective date
Jul 1, 2026
We identified it
Aug 1, 2026
Days to comply

Summary

Michigan Medicaid is implementing CPT/HCPCS code updates effective July 1, 2026, including new codes for physicians/clinics, hospitals, ASCs, and other providers; new coverage for existing codes; removal of prior authorization requirements for three equipment codes; and discontinuation of five codes. Additionally, a correction to hearing aid professional services billing clarifies separate reimbursement rules for conformity evaluations.

Action Required

Action needed
By July 1, 2026: (1) Billing team must update billing software to activate new HCPCS codes (A9574, J0528, J1289, J1577, J2361, J2374, J2789, J3405 with PA flag, J7176, J9053, J9062, J9232, Q5164, Q5166, Q5167) for appropriate provider types based on scope of practice. (2) Enable new coverage for existing codes (J0166, Q5148 for physicians/practitioners/clinics; 0356U with PA flag for laboratory; L6882, L7009, L7045 with PA flags for medical suppliers/orthotists/prosthetists; J0166 for podiatry, oral/maxillofacial surgery, FQHC, RHC, tribal health, and other specified providers). (3) Remove prior authorization requirements from K0105, E0968, and E0969 in billing system. (4) Discontinue billing J0911, C9309, 0029U, 0031U, 0423U, and 0577U effective June 30, 2026. (5) Update encounter forms and provider education materials to reflect these changes. (6) For hearing aid services: revise billing protocols to allow separate reimbursement of CPT 92638 and/or 92639 performed within 90 days of hearing aid dispensing as standalone services (effective Jan 1, 2026 retroactively). Failure to implement these changes will result in claim denials for incorrectly coded or authorized services. Reference MDHHS website (michigan.gov/medicaidproviders) and CHAMPS system for complete fee schedules and coverage parameters.

Affected Billing Codes

A9574
J0528
J1289
J1577
J2361
J2374
J2789
J3405
J7176
J9053
J9062
J9232
Q5164
Q5166
Q5167
J0166
Q5148
L6882
L7009
L7045
K0105
E0968
E0969
J0911
C9309
92638
92639