MedicaidPrior AuthMedium impact
MMP 25-08: Upper Extremity Prostheses
Michigan Medicaid - MDHHS·MI · Orthopedics, PM&R (Physical Medicine & Rehab), Occupational Therapy +1 more·Provider Bulletin
Effective date
May 1, 2025
We identified it
Jun 20, 2026
Summary
Michigan Medicaid is expanding coverage for upper extremity prostheses to include passive and myoelectric prostheses starting May 1, 2025. Prior authorization is required for all upper extremity prostheses, and specific clinical team evaluations must be documented for coverage.
Action Required
By May 1, 2025: Billing team must update systems to require prior authorization for all upper extremity prostheses codes. Providers must ensure clinical team evaluations (physician/prosthetist/OT or PT) are documented and less than 90 days old before billing. Update encounter forms to include warranty documentation requirements and manufacturer warranty information in patient files.