6 March, 2023 17:08

See below along with the attached PDF. This is for Michigan Medicaid, including RHCs, after the end of the PHE, effective 5/12/2023.

In summary, telehealth CAN continue for RHCs, modifiers change to 95 (instead of GT) for audio/visual and 93 (instead of GT) for audio-only.

If the visit is allowed in an RHC and can be done via telehealth, then it’s paid at your PPS/AIR, the exception would be audio-only which has only CERTAIN CPTs allowed, see below.

Something to note, audio-only does not include "higher" level CPTs 99213, 99214, or 90837, etc.

Also, note that if an RHC does the 99441-99443, then it’s not going to be paid at the AIR since those codes DO NOT count as an RHC visit. If all conditions are met the better option would be 99212 with modifier 93 (audio-only).

These procedure codes include the telephone-only CPT/HCPCS codes (99441-99443 and 98955-98968) along with the following codes:
1. Physical Health/Mild-to-Moderate Behavioral Health:

a. Psychotherapy services for adult or child (up to 45 minutes) (90832, 90834, 90839, 90840, and 90785)
b. Genetic and preventative counseling services (96040)
c. Risk Assessments (96160 and 96161)
d. Office visits for established patients up to 19 minutes (99212)
e. Preventative counseling (99401, 99402, 99403, and 99404), Behavioral Change Counseling for smoking (99406, 99407), and diabetes management (G0108)

f. Screening Brief Intervention and Referral to Treatment Services (SBIRT) (99408 and 99409)
g. Transitional Care Management Services (99495, 99496)
h. Inpatient Follow-up Services (G0406, G0407 and G0408)

2. Specialty Behavioral Health Services:

a. Psychotherapy services for adult or child (up to 45 minutes) (90832, 90834, 90839, 90840, and 90785)
b. Assertive Community Treatment (ACT) (psychiatric services only) (H0039)
c. Crisis Intervention (H2011) Note: does not include H2011 ICSS for Children
d. Office visits for established patients up to 19 minutes (Psychiatrist) (99212)
e. Assessments—Interpretation or explanation of results (90887)
f. Substance Use Disorder Individual Assessment (H0001)
g. Substance Use Disorder Outpatient Treatment (H0004)
h. Substance Use Disorder Early Intervention (H0022)
i. Substance Abuse—Outpatient Care-Recovery Supports (T1012)
j. Supportive Employment Services for Individuals (including job coaching) (H2023 and H2025)
k. Clubhouse Psychosocial Rehabilitation Programs (H2030)

NOTE: Current Procedural Terminology (CPT) coding changes occur frequently. Providers should consult with MDHHS fee schedules for current allowable codes which can be accessed on the MDHHS website at www.michigan.gov/medicaidproviders >> Billing and Reimbursement >> Provider Specific Information. The Medicaid Code and Rate Reference Tool, located via the External Links menu in CHAMPS, may also be used to determine eligible reimbursement codes.

link to memo