Suggested Managed Care Rates:
Clinic-PPS Visit Codes:
Multiple Visit Codes:
Clinic Qualifying Visits:
To ensure a procedure code listed in the above qualifying visits database is a covered service for your clinic type, refer to the separate procedure code coverage databases below.
Refer to the chapter for your specific provider type in the Michigan Medicaid Provider Manual for additional information on the allowable encounters per day. The Medicaid Provider Manual is available on the MDHHS website at www.michigan.gov/medicaidproviders >> Policy, Letters & Forms.
The information provided on this page serves as a reference only. It does not establish payment methodologies for third parties. Services are eligible to receive the Prospective Payment System (PPS) rate for Federally Qualified Health Centers and Rural Health Centers, or All Inclusive Rates (AIR) for the Tribal Health Centers when they meet the definition of an encounter, are billed appropriately, and do not exceed the encounter limits described in the Michigan Medicaid Provider Manual. Providers are instructed to refer to the Medicaid Provider Manual, Medical Services Administration Bulletins, and other relevant policy information for specific coverage, limits, and billing policies. Procedure codes on this list are subject to change. Any discrepancy between the information on this page and the Medicaid Provider Manual will be resolved in favor of the Provider Manual language.
Federally Qualifed Health Centers (FQHC)
Clinic Excluded Procedure Codes (FQHC only):
Clinic Dental APM Count Table:
Rural Health Centers (RHC)
Clinic Excluded Technical Payments Table (independent RHC only):
Clinic Excluded Procedure Codes (RHC only):
Tribal Health Centers (THC)
Clinic Excluded Procedure Codes (THC only):