Out of State Providers
In alignment with the Michigan Insurance Code of 1956 (Act 218 of 1956), telemedicine services must be provided by a health care professional who is licensed, registered, or otherwise authorized to engage in their health care profession in the state where the beneficiary is located. The provider at the distant site who is licensed under State law to furnish a covered telemedicine service (as described in telemedicine policy) may bill, and receive payment for, the service when it is delivered via a telecommunications system.
Telemedicine providers must be enrolled in Michigan Medicaid and must have the ability to refer the beneficiary to another provider of the same type or specialty who can see the beneficiary in-person when necessary. If rendering services within a managed care plan, providers must refer beneficiaries to resources within the plan for additional services as needed.
Michigan Medicaid telemedicine policy permits providers who are licensed in another state to render/be reimbursed for telemedicine services for Michigan Medicaid-enrolled beneficiaries if the beneficiary is in the state where the provider is licensed. Unless otherwise specified in policy, telemedicine providers associated to a billing provider located outside of Michigan must obtain prior authorization (PA) for services.
Providers should refer to the Out-of-State/Beyond Borderland Providers subsection in the General Information for Providers chapter for situations where PA could be approved. Refer to the PSYPACT subsection for specific situations where an out-of-state licensed provider is otherwise authorized to render/be reimbursed for telemedicine services.
Telemedicine providers who do not have a physical location for treatment, but are Michigan licensed and meet all other Medicaid enrollment requirements, are considered “virtual-only” and are permitted to render services for Michigan Medicaid-enrolled beneficiaries.
Virtual-only providers not associated to a Michigan billing provider within the Community Health Automated Medicaid Processing System (CHAMPS) will be subject to out-of-state provider PA requirements. Providers should refer to the Out-of-State/Beyond Borderland Providers subsection in the General Information for Providers chapter for situations where PA could be approved.
Virtual-only providers must report Place of Service (POS) 02 or 10 along with the appropriate modifier when submitting claims/encounters for telemedicine.
Telemedicine providers who have an Authority to Practice Interjurisdictional Telepsychology (APIT) certificate from the Psychology Interjurisdictional Compact (PSYPACT) Commission are eligible to render/be reimbursed for telemedicine services for Medicaid beneficiaries as authorized under PSYPACT and allowed by Medicaid telemedicine policy.
PSYPACT providers must abide by the same telemedicine requirements as all other telemedicine providers. Services performed by PSYPACT providers are subject to PA requirements that would apply if the provider were located in-state. Providers should refer to the CHAMPS Code Rate and Reference tool for service-specific in-state authorization requirements.
PSYPACT providers must report POS 02 or 10 along with the appropriate modifier when submitting claims/encounters for telemedicine.
Behavioral health services may be delivered via telemedicine in accordance with current Medicaid policy. In compliance with the Michigan Insurance Code of 1956 (Act 218 of 1956), telemedicine services must be provided by a health care professional who is licensed, registered, or otherwise authorized to engage in their health care profession in the state where the patient is located. Refer to the Telemedicine Chapter for additional information regarding telemedicine services.
Asynchronous Interprofessional Consultations
In consultations that cross state lines, consulting providers must be an enrolled Medicaid provider in the state in which the beneficiary resides, though they need only be licensed/credentialed in the state in which they are practicing. Interprofessional consultations that occur across state lines require prior authorization. Refer to the MDHHS Medicaid Provider Manual for further information regarding out-of-state/beyond borderland providers and the prior authorization process.
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2239, Jan. 1, 2026. (Accessed Jan. 2026).
Assertive Community Treatment Programs (ACT)
Typically, although not exclusively, physician activities may include team meetings, beneficiary appointments during regular office hours, psychiatric evaluations, psychiatric meetings/consultations, medication reviews, home visits, telephone consultations and telemedicine.
The physician (MD or DO) must possess a valid license to practice medicine in Michigan, a Michigan Controlled Substance License, and a Drug Enforcement Administration (DEA) registration.
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 390, Jan. 1, 2026 (Accessed Jan. 2026).
< BACK TO RESOURCES