Clinic Institutional Billing

Revenue Code Requirement Table

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.

For additional pertinent coverage parameters, such as documentation and billing indicators, refer to the Medicaid Code and Rate Reference tool, which is accessible via the External Links menu within CHAMPS. Medicaid Code and Rate Reference is an online code inquiry system that provides real-time information for the following:

  • Age restrictions,
  • Diagnoses allowable for Ambulance,
  • Documentation requirements,
  • Frequency limitations,
  • Hospital discharge – Bypass PA
  • NDC information,
  • Prior authorizations and medical conditions that may bypass these requirements,
  • Rate information,
  • Required modifiers,
  • Supplies/DME – per diem, and
  • Tooth number and surface requirements.

To request or view upcoming training sessions please refer to Michigan Department of Health and Human Services website at www.michigan.gov/medicaidproviders >> Communications and Training >> Medicaid Provider Training Sessions.

Questions should be directed to Provider Inquiry, Michigan Department of Health and Human Services, phone toll free 1-800-292-2550 or email providersupport@michigan.gov.

 

Federally Qualified Health Center (FQHC)

Clinic-PPS Visit Codes will reimburse at the provider’s PPS rate. FQHC Clinic-PPS Visit Codes must be billed with a Qualifying Visit to receive payment.

Multiple Visit Codes will be reimbursed at the providers' PPS rate multiplied by the appropriate Qualifying Visit count.

Clinic-Excluded High Cost Codes (FQHC only) will be reimbursed using the existing CHAMPS code rates.

The suggested MCO Reimbursement Rate can be found at the top of each reimbursement list located in the drop-down menu below.

Choose One   

 

Rural Health Clinic (RHC)

Clinic-PPS Visit Codes will reimburse at the provider’s PPS rate. RHC Clinic-PPS Visit Codes must be billed with a Qualifying Visit to receive payment.

Multiple Visit Codes will be reimbursed at the providers' PPS rate multiplied by the appropriate Qualifying Visit count.

Clinic-Excluded High Cost Codes (RHC only) will be reimbursed using the existing CHAMPS code rates.

Clinic-Excluded Technical Payment codes will be reimbursed at the technical component of the code rates for Independent RHC providers.

The suggested MCO Reimbursement Rate can be found at the top of each reimbursement list located in the drop-down menu below.

Choose One   

 

Tribal Health Center (THC)

Clinic-PPS Visit Codes will reimburse at the provider’s All-Inclusive Rate (AIR). THC Clinic-PPS Visit Codes must be billed with a Qualifying Visit to receive payment.

Multiple Visit Codes will be reimbursed at the AIR multiplied by the appropriate Qualifying Visit count.

Clinic-Excluded High Cost Codes (THC only) will be reimbursed using the existing CHAMPS code rates.

 

The suggested MCO Reimbursement Rate can be found at the top of each reimbursement list located in the drop-down menu below.

Choose One   

 

Historical Information preceding January 2019