MedicaidBilling CodesHigh impact
MMP 25-14: Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) Code Updates
Michigan Medicaid - MDHHS·MI·Claims & Billing
Effective date
Apr 1, 2025
We identified it
Jun 20, 2026
Summary
Michigan Medicaid has implemented multiple CPT/HCPCS code changes with various effective dates: new codes added (April 1), existing codes activated for additional provider types (April 1 and May 1), new prior authorization requirements (March 1), and discontinued codes (March 31). This affects billing for Medicaid, Healthy Michigan Plan, Children's Special Health Care Services, and MI Health Link programs.
Action Required
Immediately: Billing team must update Michigan Medicaid billing systems to (1) activate new HCPCS codes effective April 1, 2025 for applicable provider types, (2) add prior authorization requirements for E1161, E1231-E1238, K0005, and K0040 effective March 1, 2025, (3) stop billing discontinued codes 90476, 90584, 90644, 90759 and multiple J-codes effective March 31, 2025, and (4) verify provider type eligibility for each new code as specified in the bulletin. Update encounter forms and staff training. Claims using discontinued codes or missing required prior authorizations will be denied.