Michigan

Disclaimer

PLEASE NOTE: CCHP is providing the following for informational purposes only. We are not providing legal advice or interpretation of the laws and regulations and policies. CCHP encourages you to check with the appropriate state agency for further information and direction. This information should not be construed as legal counsel. Consult with an attorney if you are seeking a legal opinion.

At A Glance
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MEDICAID REIMBURSEMENT

  • Live Video: Yes
  • Store-and-Forward: Yes
  • Remote Patient Monitoring: Yes
  • Audio Only: Yes

PRIVATE PAYER LAW

  • Law Exists: Yes
  • Payment Parity: No

PROFESSIONAL REQUIREMENTS

  • Licensure Compacts: IMLC
  • Consent Requirements: Yes

FQHCs

  • Originating sites explicitly allowed for Live Video: Yes
  • Distant sites explicitly allowed for Live Video: Yes
  • Store and forward explicitly reimbursed: No
  • Audio-only explicitly reimbursed: Yes
  • Allowed to collect PPS rate for telehealth: Yes

STATE RESOURCES

  1. Medicaid Program: Michigan Medicaid
  2. Administrator: Michigan Dept. of Health and Human Services (MDHHS)
  3. Michigan Dept. of Health and Human Services (MDHHS): Upper Midwest Telehealth Resource Center
Disclaimer

PLEASE NOTE: CCHP is providing the following for informational purposes only. We are not providing legal advice or interpretation of the laws and regulations and policies. CCHP encourages you to check with the appropriate state agency for further information and direction. This information should not be construed as legal counsel. Consult with an attorney if you are seeking a legal opinion.

Last updated 09/04/2022

Audio Only Delivery

Medicaid: Relaxing Face-to-Face Requirement (Update)

STATUS: Active, time limited policy and MDHHS will notify providers of its termination

Medicaid: Specialty Behavioral Health Supports and Services

STATUS: Active, time limited policy and MDHHS will notify providers of its termination

Medicaid: Limited Oral Evaluation via Telemedicine

STATUS: Active, time limited policy however expiration date not specified

Medicaid: Behavioral Health Telepractice; Telephone Services

STATUS: Active, time limited policy and MDHHS will notify providers of its termination

Medicaid: Telemedicine Reimbursement for FQHCs, RHCs, Tribal Health Centers

STATUS: Active, time limited policy and MDHHS will notify providers of its termination

Medicaid: Medicaid Compliance with Interim Final Rule CMS-5531: Improving Care Planning for Medicaid Home Health Services; COVID-19 Response: Temporary Waiver of Beneficiary Signature for Home- Delivered DMEPOS

STATUS: Active, time limited policy and MDHHS will notify providers of its termination

Medicaid: Correction to Bulletin MSA 20-35, Medicaid Compliance with Interim Final Rule CMS-5531: Improving Care Planning for Medicaid Home Health Services;

STATUS: Active, time limited policy and MDHHS will notify providers of its termination

Medicaid 1915(c) Waiver: Appendix K -MI Health Link Home and Community Based Services Waiver

STATUS: Expired February 28, 2021; extended by Addendum

Medicaid 1915(c) Waiver: Appendix K- MI Health Link Home and Community Based Services Waiver

STATUS: Active until six months after the conclusion of the PHE

Medicaid 1915(c) Waiver: Appendix K – MI Choice

STATUS: Expired February 28, 2021; extended by Addendum

Medicaid 1915(c) Waiver: Appendix K- MI Choice

STATUS: Active until six months after the conclusion of the PHE

Medicaid 1915(c) Waiver: Appendix K – Habilitation Supports, Children’s Waiver Program (CWP) Waiver for Children with Serious Emotional Disturbances (SEDW)

STATUS: Expired February 28, 2021; extended by Addendum

Medicaid 1915(c) Waiver: Appendix K – Habilitation Supports, Children’s Waiver Program (CWP) Waiver for Children with Serious Emotional Disturbances (SEDW)

STATUS: Active until no later than six months after the expiration of the PHE

Last updated 11/22/2022

Cross State Licensing

No reference found.

Last updated 11/22/2022

Easing Prescribing Requirements

No reference found.

Last updated 11/22/2022

Miscellaneous

Previous COVID-19 waivers expired.

Last updated 09/04/2022

Originating Site

Medicaid:  General Telemedicine Policy

STATUS: Remain in effect until incorporated into the manual.

Medicaid: Telemedicine Reimbursement for FQHCs, RHCs, Tribal Health Centers

STATUS: Active, time limited policy and MDHHS will notify providers of its termination

Medicaid: Medicaid Compliance with Interim Final Rule CMS-5531: Improving Care Planning for Medicaid Home Health Services; COVID-19 Response: Temporary Waiver of Beneficiary Signature for Home- Delivered DMEPOS

STATUS: Active, time limited policy and MDHHS will notify providers of its termination

Medicaid: Correction to Bulletin MSA 20-35, Medicaid Compliance with Interim Final Rule CMS-5531: Improving Care Planning for Medicaid Home Health Services;

STATUS: Active, time limited policy and MDHHS will notify providers of its termination

Medicaid 1915(c) Waiver: Appendix K -MI Health Link Home and Community Based Services Waiver

STATUS: Expired February 28, 2021; extended by Addendum

Medicaid 1915(c) Waiver: Appendix K- MI Health Link Home and Community Based Services Waiver

STATUS: Active until six months after the conclusion of the PHE

Medicaid 1915(c) Waiver: Appendix K – MI Choice

STATUS: Expired February 28, 2021; extended by Addendum

Medicaid 1915(c) Waiver: Appendix K- MI Choice

STATUS: Active until six months after the conclusion of the PHE

Medicaid 1915(c) Waiver: Appendix K – Habilitation Supports, Children’s Waiver Program (CWP) Waiver for Children with Serious Emotional Disturbances (SEDW)

STATUS: Expired February 28, 2021; extended by Addendum

Medicaid 1915(c) Waiver: Appendix K – Habilitation Supports, Children’s Waiver Program (CWP) Waiver for Children with Serious Emotional Disturbances (SEDW)

STATUS: Active until no later than six months after the expiration of the PHE

Last updated 11/22/2022

Private Payer

No reference found.

Last updated 09/04/2022

Provider Type

Medicaid:  General Telemedicine Policy

STATUS: Remain in effect until incorporated into Medicaid manual

Medicaid: Telemedicine Policy Changes, Physical, Occupational and Speech Therapy

STATUS: Active, time limited policy and MDHHS will notify providers of its termination

Medicaid: Telemedicine Reimbursement for FQHCs, RHCs, Tribal Health Centers

STATUS: Active, time limited policy and MDHHS will notify providers of its termination

Medicaid: Medicaid Compliance with Interim Final Rule CMS-5531: Improving Care Planning for Medicaid Home Health Services; COVID-19 Response: Temporary Waiver of Beneficiary Signature for Home- Delivered DMEPOS

STATUS: Active, time limited policy and MDHHS will notify providers of its termination

Medicaid: Correction to Bulletin MSA 20-35, Medicaid Compliance with Interim Final Rule CMS-5531: Improving Care Planning for Medicaid Home Health Services;

STATUS: Permanent

Medicaid 1915(c) Waiver: Appendix K – MI Choice

STATUS: Expired February 28, 2021; extended by Addendum

Medicaid 1915(c) Waiver: Appendix K- MI Choice

STATUS: Active until six months after the conclusion of the PHE

Medicaid 1915(c) Waiver: Appendix K – Habilitation Supports, Children’s Waiver Program (CWP) Waiver for Children with Serious Emotional Disturbances (SEDW)

STATUS: Expired February 28, 2021; extended by Addendum

Medicaid 1915(c) Waiver: Appendix K – Habilitation Supports, Children’s Waiver Program (CWP) Waiver for Children with Serious Emotional Disturbances (SEDW)

STATUS: Active until no later than six months after the expiration of the PHE

Last updated 09/04/2022

Service Expansion

Medicaid:  General Telemedicine Policy

STATUS: Active, until incorporated into manual.

Medicaid: Specialty Behavioral Health Supports and Services

STATUS: Active, time limited policy and MDHHS will notify providers of its termination

Medicaid: Limited Oral Evaluation via Telemedicine

STATUS: Active, time limited policy however expiration date not specified

Medicaid: Behavioral Health Telepractice; Telephone Services

STATUS: Active, time limited policy and MDHHS will notify providers of its termination

Medicaid: Telemedicine Policy Changes, Physical, Occupational and Speech Therapy

STATUS: Active, time limited policy and MDHHS will notify providers of its termination

Medicaid: Telemedicine Policy Rate Change

STATUS: Active, time limited policy however expiration date not specified

Medicaid: Telemedicine Policy Change for Audiology

STATUS: Active, time limited policy and MDHHS will notify providers of its termination

Medicaid: Medicaid Compliance with Interim Final Rule CMS-5531: Improving Care Planning for Medicaid Home Health Services; COVID-19 Response: Temporary Waiver of Beneficiary Signature for Home- Delivered DMEPOS

STATUS: Active, time limited policy and MDHHS will notify providers of its termination

Medicaid: Correction to Bulletin MSA 20-35, Medicaid Compliance with Interim Final Rule CMS-5531: Improving Care Planning for Medicaid Home Health Services;

STATUS: Permanent

Medicaid 1915(c) Waiver: Appendix K – Habilitation Supports, Children’s Waiver Program (CWP) Waiver for Children with Serious Emotional Disturbances (SEDW)

STATUS: Expired February 28, 2021; extended by Addendum

Medicaid 1915(c) Waiver: Appendix K – Habilitation Supports, Children’s Waiver Program (CWP) Waiver for Children with Serious Emotional Disturbances (SEDW)

STATUS: Active, until six months after the expiration of the PHE

Last updated 11/22/2022

Definitions

“Telemedicine means the use of an electronic media to link patients with health care professionals in different locations. To be considered telemedicine under this section, the health care professional must be able to examine the patient via a HIPPA compliant, secure interactive audio or video, or both, telecommunications system, or through the use of store and forward online messaging.”

SOURCE: MI Compiled Law Svcs. Sec. 500.3476(2)(b) (Accessed Nov. 2022).

Last updated 11/22/2022

Parity

SERVICE PARITY

Insurers and health care corporations must cover services appropriately provided through telemedicine, as determined by the insurer or health care corporation.

SOURCE: MI Compiled Law Services Sec. 500.3476 & Sec. 550.1401k. (Accessed Nov. 2022).


PAYMENT PARITY

No explicit payment parity.

Last updated 11/22/2022

Requirements

An insurer that delivers, issues for delivery, or renews in this state a health insurance policy or a group or nongroup health care corporation certificate shall not require face-to-face contact between a health care professional and a patient for services appropriately provided through telemedicine, as determined by the insurer or health care corporation. Telemedicine services must be provided by a health care professional who is licensed, registered, or otherwise authorized to engage in his or her health care profession in the state where the patient is located. Telemedicine services are subject to all terms and conditions of the health insurance policy agreed upon between the policy holder and the insurer or the certificate agreed upon between the certificate holder and the health care corproation, including, but not limited to, required copayments, coinsurances, deductibles, and approved amounts.

SOURCE: MI Compiled Law Services Sec. 500.3476(1) & Sec. 550.1401k(1). (Accessed Nov. 2022).

Last updated 11/22/2022

Definitions

“Telemedicine” means the use of an electronic media to link patients with health care professionals in different locations. To be considered telemedicine under this section, the health care professional must be able to examine the patient via a health insurance portability and accountability act of 1996, Public Law 104-191 compliant, secure interactive audio or video, or both, telecommunications system, or through the use of store and forward online messaging.

SOURCE: MI Compiled Law Services, Section 330.1100(d)(16), (Accessed Nov. 2022).

“Telemedicine” means the use of an electronic media to link patients with health care professionals in different locations. To be considered telemedicine under this section, the health care professional must be able to examine the patient via a health insurance portability and accountability act of 1996, Public Law 104-191 compliant, secure interactive audio or video, or both, telecommunications system, or through the use of store and forward online messaging.”

SOURCE: MI Compiled Law Svcs. Sec. 500.3476(2)(b) & MI Compiled Law Services Sec. 5501401k(2). (Accessed Nov. 2022).

“Telemedicine is the use of telecommunication technology to connect a patient with a health care professional in a different location. MDHHS requires a real time interactive system at both the originating and distant site, allowing instantaneous interaction between the patient and health care professional via the telecommunication system. Telemedicine should be used primarily when travel is prohibitive for the beneficiary or there is an imminent health risk justifying immediate medical need for services.”

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p.1886, Oct. 1, 2022 (Accessed Nov. 2022). 

Assertive Community Treatment Program (ACT)

Telepractice is the use of telecommunications and information technologies for the provision of psychiatric services to ACT consumers and is subject to the same service provisions as psychiatric services provided in-person.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 352 Oct. 1, 2022  (Accessed Nov. 2022). 

Behavioral Health Treatment Services (BHT)

Telepractice is the use of telecommunications and information technologies for the exchange of encrypted patient data for the provision of services (e.g., access or travel to needed medical services may be prohibitive). Telepractice must be obtained through real-time interaction between the child’s physical location (patient site) and the provider’s physical location (provider site). Telepractice services are provided to patients through hardwire or internet connection.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 484 Jul. 1, 2022 (Accessed Sept. 2022).

Telemedicine for BHT Services

Telemedicine is the use of telecommunications and information technologies for the exchange of encrypted patient data for the provision of services (e.g., access or travel to needed medical services may be prohibitive). Telemedicine must be obtained through real-time interaction between the individual’s physical location (patient site) and the provider’s physical location (provider site). Telemedicine services are provided to patients through hardwire or internet connection.

SOURCE: MSA Bulletin 21-20, (Sept. 1, 2021), (Accessed Nov. 2022).

Telepractice for BHT Services

Telepractice is the use of telecommunications and information technologies for the exchange of encrypted patient data for the provision of services (e.g., access or travel to needed medical services may be prohibitive). Telepractice must be obtained through real-time interaction between the child’s physical location (patient site) and the provider’s physical location (provider site). Telepractice services are provided to patients through hardwire or internet connection.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p.485, Oct. 1, 2022. (Accessed Nov. 2022).

Medication Therapy Management

Telepractice is the use of telecommunications and information technologies for the exchange of encrypted patient data for the provision of services. Telepractice must be obtained through real-time interactions between the beneficiary’s physical location (origin site) and the pharmacist provider’s physical location (distant site). Telepractice services are provided to beneficiaries through hardwire or internet connection.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 1806 Oct. 1, 2022 (Accessed Nov. 2022). 

Speech, Language and Hearing Therapy, School-Based Services

“Telepractice is the use of telecommunications and information technologies for the exchange of encrypted patient data for the provision of speech, language and hearing services. Telepractice must be obtained through real-time interaction between the patient’s physical location (patient site) and the provider’s physical location (provider site).” Services are provided to patients through hardwire or internet connection.

SOURCE: MI Dept. of Health and Human Services Medicaid Provider Manual, p. 1988 & 1990 Oct. 1, 2022 (Accessed Nov. 2022).

Child Therapy

Telepractice/Telehealth is the use of telecommunications and information technologies for the exchange of encrypted patient data for the provision of services (e.g., access or travel to needed therapy services may be prohibitive). Telepractice/Telehealth must be obtained through real-time interaction between the child’s/family’s physical location and the provider’s physical location. Telepractice/Telehealth services are provided to patients through hardwire or internet connection.

SOURCE:  MI Dept. of Health and Human Services Medicaid Provider Manual, p. 337, Oct. 1, 2022. (Accessed Nov. 2022).

Last updated 11/22/2022

Email, Phone & Fax

Interprofessional Telephone/Internet/Electronic Health Record Consultations

Interprofessional telephone/Internet/electronic health record consultations, including e-Consults, are a type of asynchronous telemedicine service in which the beneficiary’s Medicaid-enrolled treating physician (e.g., attending or primary) or practitioner requests the opinion and/or treatment advice of a Medicaid enrolled physician or practitioner with the specialty expertise to assist in the diagnosis of a condition and/or management of the beneficiary’s condition without beneficiary face-to-face contact with the consultant. The service concludes with a written report from the consultant to the treating physician/requesting provider.

The beneficiary for whom the service is requested may be either a new patient to the consulting provider or an established patient with a new problem. Service time is based on the total review and interprofessional communication time. The review of beneficiary information, including but not limited to medical records, laboratory studies, imaging studies, medications, and pathology specimens, is included in the service and should not be separately reported. The written or verbal request for the consult must be documented in the beneficiary’s medical record by the treating physician/requesting provider. Providers must consult with the American Medical Association (AMA) coding guidelines to ensure appropriate reporting of these services. Providers should not report interprofessional telephone/Internet/electronic health record consultations when the sole purpose of the communication is to arrange a transfer of care or other face-to-face service.

SOURCE: Medical Services Administration (MSA) Bulletin 21-24 Aug. 2021. (Accessed Nov. 2022).

Medication Therapy Management (MTM)

The following are not eligible to be covered as MTM services:

Services provided by telephone, email or US Postal Service Mail.

SOURCE: MI Medicaid Provider Manual, p. 1804 Oct. 1, 2022 (Accessed Nov. 2022).

Telemedicine Coding Changes

MDHHS acknowledges the addition of POS 10-Telehealth provided in a patient’s home, the new definition of POS 02-Telehealth provided other than in a patient’s home, and the addition of modifier FQ-audio only service.

MDHHS will require modifier FQ to be appended in addition to modifier GT. When a provider submits modifier FQ for an audio only service, the provider does not need to include a note in the remarks section stating that the service was provided via telephone (per bulletin MSA 20-13). Please note, modifier GT must be included for the claim to be processed correctly. For FQHCs/RHCs/THCs and Tribal FQHCs, please use modifier GT and modifier FQ as indicated above.

Further updates to telemedicine reporting will be provided in future bulletins.

SOURCE: MI Health and Aging Services Administration Bulletin HASA 22-03 (Feb. 8, 2022), (Accessed Nov. 2022).

Last updated 09/03/2022

Live Video

POLICY

MDHHS requires a real time interactive system at both the originating and distant site, allowing instantaneous interaction between the patient and health care professional via the telecommunication system. Telemedicine should be used primarily when travel is prohibitive for the beneficiary or there is an imminent health risk justifying immediate medical need for services.

Source: Dept. of Health and Human Services, Medicaid Provider Manual, p. 1888. Jul. 1, 2022 (Accessed Sept. 2022). 

Assertive Community Treatment Program

All telepractice interactions shall occur through real-time interactions between the ACT consumer and the physician/nurse practitioner/clinical nurse specialist from their respective physical location. Psychiatric services are the only ACT services that are approved to be provided in this manner.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 352 Jul. 1, 2022 (Accessed Sept. 2022)


ELIGIBLE SERVICES/SPECIALTIES

The following services may be provided via telemedicine:

  • ESRD-related services
  • Behavior change intervention
  • Behavioral Health and/or Substance Use Disorder Treatment
  • Education Services, Telehealth
  • Inpatient consultations
  • Nursing facility subsequent care
  • Office or other outpatient consultations
  • Office or other outpatient services
  • Psychiatric diagnostic procedures
  • Subsequent hospital care
  • Training service – Diabetes (see Diabetes Self-Management Education Training Program section in Hospital Chapter specific program requirements)

Where face-to-face visits are required (such as ESRD and nursing facility related services), the telemedicine service may be used in addition to the required face-to-face visit but cannot be used as a substitute. There must be at least one face-to-face hands-on visit (i.e., not via telemedicine) by a physician, physician’s assistant or advanced practice registered nurse per month to examine the vascular site for ESRD services. The initial visit for nursing facility services must be face-to-face.

Procedure codes and modifier information is contained in the MDHHS Telemedicine Services Database.

There is no prior authorization requirements when providing telemedicine services for fee-for-service beneficiaries.

Authorization requirements for beneficiaries enrolled in Medicaid Health Plans (MHPs) may vary. Providers must check with individual MHPs for any authorization or coverage requirements.

Providers at the distant site can only bill services listed in the Telemedicine Services database.

SOURCE: Dept. of Health and Human Services, Medicaid Provider Manual, p. 1888-9, Jul. 1, 2022 (Accessed Sept. 2022).  

Listed below are HCPCS codes being adopted by MDHHS for dates of service on and after April 1, 2022, and the provider groups allowed to bill these codes. These codes must not be reported with POS 02 nor the GT modifier and will be represented on the applicable provider fee schedules and not the telemedicine database. They are, by definition, technology enabled and do not need the telemedicine POS or modifier to identify them appropriately.  See bulletin for code list.

SOURCE: MI Dept. of Health and Human Services, Medicaid Bulletin, 7/5/22, (Accessed Sept. 2022).

Speech-Language and Audiology Services

Speech, language and hearing services may be reimbursed. Requires an annual referral from a physician. In addition to the use of the appropriate billing code, billers use the “GT modifier to identify services provided by telepractice.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 1990, Jul. 1, 2022 (Accessed Sept. 2022). 

Assertive Community Treatment Program

The telepractice modifier, 95, must be used in conjunction with ACT encounter reporting code H0039 when telepractice is used.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 351 July. 1, 2022 (Accessed Sept. 2022). 

Telepractice for BHT Services

Telepractice services must be prior authorized.  Telepractice must be obtained through real-time interaction between the child’s physical location (patient site) and the provider’s physical location (provider site). Telepractice services are provided to patients through hardwire or internet connection. It is the expectation that providers, facilitators, and staff involved in telepractice are trained in the use of equipment and software prior to servicing patients, and services provided via telepractice are provided as part of an array of comprehensive services that include in-person visits and assessments with the primary supervising BHT provider. Qualified providers of behavioral health services are able to arrange telepractice services for the purposes of teaching the parents/guardians to provide individualized interventions to their child and to engage in behavioral health clinical observation and direction (i.e. increase oversight of the provision of services to the beneficiary to support the outcomes of the behavioral plan of care developed by the primary supervising BHT provider).

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 484 Jul. 1, 2022 (Accessed Sept. 2022). 

Telemedicine/Telepractice for BHT Services

Refer to the Behavioral Health Telemedicine reporting requirements database for appropriate or allowed telemedicine services that may be covered by Medicaid. Certain qualifications and conditions will also need to be met. Use GT modifier in addition to appropriate procedure code.

It is the expectation that providers, facilitators, and staff involved in telemedicine are trained in the use of equipment and software prior to servicing patients and services provided via telemedicine are provided as part of an array of comprehensive services that include in-person visits and assessments with the primary supervising BHT provider. The provider of the telemedicine service is only able to monitor one child/family at a time.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 484, 1888-1890 Jul. 1, 2022 (Accessed Sept. 2022).

Child Therapy

A child mental health professional may provide child therapy on an individual or group basis with a family-driven, youth-guided approach. Telepractice/Telehealth is approved for Individual Therapy or Family Therapy using approved children’s evidence-based practices (i.e., Trauma Focused Cognitive Behavioral Therapy, Parent Management Training-Oregon, Parenting Through Change) and utilizes the GT modifier when reporting the service.  Qualified providers of children’s evidence-based practices have completed their training in the model, its implementation via telehealth, and are able to provide the practice with fidelity.

SOURCE:  MI Dept. of Health and Human Services Medicaid Provider Manual, p. 336 Jul. 1, 2022 (Accessed Sept. 2022). 

Psychiatric Collaborative Care Model (CoCM) Services

Provider care management services provided by a Behavioral Health Care Manager can be provided in a non-face-to-face interaction. Weekly consults with the psychiatric consultant may also be non-face-to-face. Face-to-face or non-face-to-face weekly to monthly follow-up by the behavioral health care manager that must include monthly screening with validated rating scale, monitoring of goals and/or medication, and may include recommended evidence-based therapies.

SOURCE:  MI Dept. of Health and Human Services Medicaid Provider Manual, p. 1883 Jul. 1, 2022  (Accessed Sept. 2022).

Medication Therapy Management (MTM)

In the event that the beneficiary is unable to physically access a face-to-face setting, an eligible pharmacist may provide MTM services via telepractice.  The arrangements for telepractice will be made by the pharmacist. The administration of telepractice services are subject to the same provision of services that are provided to a beneficiary in person.  For services provided through telepractice each procedure code must include the modifier GT (professional claims).

SOURCE:  MI Dept. of Health and Human Services Medicaid Provider Manual, p. 1808 Jul. 1, 2022  (Accessed Sept. 2022).

Children’s Special Health Care Services (CSHCS)

CSHCS covers services that are medically necessary, related to the beneficiary’s qualifying diagnosis(es), and ordered by the beneficiary’s CSHCS authorized specialist(s) or subspecialist(s). Services are covered and reimbursed according to Medicaid policy unless otherwise stated in this chapter.

The primary CSHCS benefits may include:

  • Telemedicine

SOURCE:  MI Dept. of Health and Human Services Medicaid Provider Manual, p. 588 Jul. 1, 2022  (Accessed Sept. 2022).


ELIGIBLE PROVIDERS

A Tribal facility may choose to enroll as a Tribal FQHC and be reimbursed for outpatient face-to-face visits within the FQHC scope of services provided to Medicaid beneficiaries, including telemedicine and services provided by contracted employees. Tribal FQHCs are eligible to receive the IHS outpatient AIR for eligible encounters.

SOURCE: Dept. of Health and Human Services Medicaid Provider Manual, p. 2124, Jul. 1, 2022 (Accessed Sept. 2022). 

Telemedicine services must be provided by a health care professional who is licensed, registered or otherwise authorized to engage in his or her health care profession in the state where the patient is located. The physician or practitioner at the distant site who is licensed under State law to furnish a covered telemedicine services (as described in the Telemedicine Services subsection) may bill, and receive payment for, the service when it is delivered via a telecommunication system. In order to be reimbursed for services, distant site providers must be enrolled in Michigan Medicaid.

SOURCE: Dept. of Health and Human Services Medicaid Provider Manual, p. 1889-90, Jul. 1, 2022 (Accessed Sept. 2022). 

Telepractice for BHT Services

Qualified providers include:

  • Board certified behavior analysts
  • Board certified assistant behavior analysts
  • Licensed psychologists
  • Limited licensed psychologists
  • Qualified behavioral health professionals

Occupational, physical and speech therapists are not included in this policy.

A facilitator trained in telepractice technology must be physically present with the patient during the entire telepractice session.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 484-485 Jul. 1, 2022 (Accessed Sept. 2022). 

Telemedicine for Behavioral Health Services

Behavioral health services may be provided by:

  • Licensed physician or psychiatrist;
  • LIcensed psychologist;
  • Limited licensed master’s level psychologist under the supervision of a licensed psychologist;
  • MDE-credentialed master’s level school psychologist;
  • Licensed master’s level marriage and family therapist;
  • Board-certified behavior analyst (BCBA);
  • Board-certified assistant behavior analyst (BCaBA) under the supervision of a BCBA;
  • Licensed master’s level professional counselor;
  • LImited licensed master’s level professional counselor under the supervision of a licensed master’s level professional counselor;
  • Licensed master’s level social worker;
  • Licensed master’s level school social worker;
  • LImited licensed master’s level social worker under the supervision of a licensed master’s level social worker; and
  • Temporary limited licensed psychologist under the supervision of a fully licensed psychologist.

SOURCE: Dept. of Health and Human Services, Medicaid Provider Manual, p. 1992-1993, Jul. 1, 2022 (Accessed Sept. 2022).

Medication Therapy Management (MTM)

In the event that the beneficiary is unable to physically access a face-to-face care setting, an eligible pharmacist may provide MTM services via telepractice.  Services must be provided through hardwire or internet connection.

SOURCE: Dept. of Health and Human Services, Medicaid Provider Manual, p. 1808,  Jul. 1, 2022 (Accessed Sept. 2022).

Prepaid Inpatient Health Plans/Community Mental Health (PIHP/CMH) can be either originating or distant sites. Practitioners must meet the provider qualifications for the covered service provided via telemedicine.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 342, Jul. 1, 2022 (Accessed Sept. 2022).

Speech-Language and Audiology Services

Eligible providers:

  • A fully licensed speech-language pathologist
  • Licensed Audiologist in Michigan
  • Speech language pathologist and/or audiology candidate under the direction of a qualified SLP or audiologist. All documentation must be reviewed and signed by the appropriately licensed SLP or licensed audiologist.
  • A limited licensed speech language pathologist under the direction of a fully licensed SLP or audiologist. All documentation must be reviewed and signed by the appropriately licensed supervising SLP or licensed audiologist.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 1990, Jul. 1, 2022 (Accessed Sept. 2022).  

Federally Qualified Health Centers, Hospital, Nursing Facility, Rural Health Centers, Tribal Health Centers

An FQHC, hospital, nursing facility,  RHC or tribal health centers can be either an originating or distant site for telemedicine services.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 737, 1003, 1525, 1952 & 2022 Jul. 1, 2022 (Accessed Sept. 2022). 

Child Therapy

A child mental health professional may provide child therapy on an individual or group basis with a family-driven, youth-guided approach. It is the expectation that providers involved in telepractice/telehealth are trained in the use of equipment and software prior to servicing children/families.

SOURCE:  MI Dept. of Health and Human Services Medicaid Provider Manual, p. 336,  Jul. 1, 2022 (Accessed Sept. 2022).

School-Based Services and Caring 4 Students Providers

Telepractice specifically applies to the SBS and C4S programs.  See Medicaid manual for requirements.

SOURCE:  MI Dept. of Health and Human Services. Bulletin 20-15, School Based Services, p 1993-1994.  Jul. 1, 2022 (Accessed Sept. 2022).


ELIGIBLE SITES

Beginning October 1, 2020, telemedicine services are covered under the medical assistance program and Healthy Michigan program if the originating site is an in-home or in-school setting, in addition to any other originating site allowed in the Medicaid provider manual or any established site considered appropriate by the provider.

SOURCE: MI Compiled Laws Sec. 400.105h. (Accessed Sept. 2022).

Tribal 638 Facilities

Tribal FQHCs are eligible to receive all-inclusive rate (AIR) reimbursement for clinic services provided outside of the four walls of the facility, including telemedicine and services provided by contracted employees.

SOURCE: MI Medical Services Administration Bulletin MSA 20-60, Sept. 1, 2020 (Accessed Sept. 2022)

Eligible originating sites:

  • County mental health clinics or publicly funded mental health facilities;
  • Federally Qualified Health Centers;
  • Hospitals (inpatient, outpatient, or Critical Access Hospitals);
  • Physician or other providers’ offices, including medical clinics;
  • Hospital-based or CAH-based Renal Dialysis Centers (including satellites);
  • Rural Health Clinics;
  • Skilled nursing facilities;
  • Tribal Health Centers

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 1889. Jul. 1, 2022 (Accessed Sept. 2022). 

Speech-Language and Audiology Services, Behavioral Health Therapy, School-Based Services & Caring 4 Students Provider

The patient site may be located:

  • Within the school (for speech-language and audiology services & School-Based and Caring 4 Students Provider);
  • The Center (Behavioral Health Therapy);
  • Home;
  • Any other established site deemed appropriate by the provider.

The room must be free from distractions so as not to interfere with the telepractice session.  A facilitator must be trained in the use of the telepractice technology and physically present at the patient site during the entire telepractice session to assist the patient at the direction of the SLP or audiologist.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 485(BHT), 1990 (SLP & Audiology), 1993 (BHT), 1993 (School-Based/Caring 4 Kids Providers) Jul. 1, 2022 (Accessed Sept. 2022). 

Federally Qualified Health Centers, Hospital, Nursing Facility, Rural Health Centers, Tribal Health Centers

An FQHC, hospital, nursing facility,  RHC or tribal health centers can be either an originating or distant site for telemedicine services.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 728, 958, 1428, 1848 & 2128 Jul. 1, 2022 (Accessed Sept. 2022). 

Telemedicine Coding Changes

MDHHS acknowledges the addition of POS 10-Telehealth provided in a patient’s home, the new definition of POS 02-Telehealth provided other than in a patient’s home, and the addition of modifier FQ-audio only service.

However, due to current systems processing restraints, MDHHS will continue to require POS 02 for all services provided via telemedicine. Per bulletin MSA 20-09, all telemedicine services, as allowable on the telemedicine database and submitted on the professional invoice, must be reported with POS 02-Telehealth and the GT-interactive telecommunication modifier. To distinguish patient’s home from other location, MDHHS is requesting that providers, as able, include the comment “patient’s home” in the remarks section.

MDHHS will require modifier FQ to be appended in addition to modifier GT. When a provider submits modifier FQ for an audio only service, the provider does not need to include a note in the remarks section stating that the service was provided via telephone (per bulletin MSA 20-13). Please note, modifier GT must be included for the claim to be processed correctly. For FQHCs/RHCs/THCs and Tribal FQHCs, please use modifier GT and modifier FQ as indicated above.

Further updates to telemedicine reporting will be provided in future bulletins.

SOURCE: MI Health and Aging Services Administration Bulletin HASA 22-03 (Feb. 8, 2022), (Accessed Sept. 2022).


GEOGRAPHIC LIMITS

No Reference Found


FACILITY/TRANSMISSION FEE

To be reimbursed for the originating site facility fee, the originating site provider must bill the appropriate telemedicine procedure code and modifier. MDHHS will reimburse the originating site provider the lesser of charge or the current Medicaid fee screen.

SOURCE: Dept. of Health and Human Services, Medicaid Provider Manual, p. 267, Jul. 1, 2022 (Accessed Sept. 2022).

Last updated 11/22/2022

Miscellaneous

No reimbursement for remote access for surgical procedures, and use of robotics.

SOURCE: Dept. of Health and Human Services, Medicaid Provider Manual, p. 1886, Oct. 1, 2022  (Accessed Nov. 2022).

Last updated 11/22/2022

Out of State Providers

Telemedicine services must be provided by a health care professional who is licensed, registered or otherwise authorized to engage in his or her health care profession in the state where the patient is located.

SOURCE: Dept. of Health and Human Services, Medicaid Provider Manual, p. 1887, Oct. 1, 2022 (Accessed Nov. 2022).  

Assertive Community Treatment Programs (ACT)

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: Dept. of Health and Human Services, Medicaid Provider Manual, p. 352, Oct. 1, 2022 (Accessed Nov. 2022).

Behavioral Health Therapy

Providers of telepractice services must be currently certified by the Behavior Analyst Certification Board (BACB), be a QBHP, be fully licensed in MI as a fully licensed psychologist, or be a practitioner who holds a limited license and is under the direction of a licensed psychologist.

SOURCE: Dept. of Health and Human Services, Medicaid Provider Manual, p. 485-486, Oct. 1, 2022 (Accessed Nov. 2022).

Last updated 11/22/2022

Overview

Michigan Medicaid reimburses for live video telemedicine for certain healthcare professionals, for patients located at certain originating sites for specific services.  A new bulletin effective Aug. 1, 2021 Medicaid reimburses for asynchronous telemedicine services, including store and forward services, interprofessional telephone/internet/electronic health record consultations and remote patient monitoring services under certain circumstances. Michigan Medicaid uses the terms “telemedicine” and “telepractice”.

Last updated 11/22/2022

Remote Patient Monitoring

POLICY

“Remote patient monitoring means digital technology to collect medical and other forms of health data from an individual in 1 location and electronically transmit that information via a health insurance portability and accountability act of 1996, Public Law 104-191 compliant, secure system to a health care provider in a different location for assessment and recommendations.”

The Department of Health and Human Services must provide coverage for remote patient monitoring services through the medical assistance program and Healthy Michigan program.

SOURCE: MI Compiled Laws Sec. 400.105g (Accessed Nov. 2022).

Remote Patient Monitoring (RPM) is a covered service under Michigan Compiled Law (MCL) 400.105g. RPM means using digital technology to collect medical and other forms of health data from an individual in one location and electronically transmit that information via a secure, HIPAA-compliant system to a health care provider in a different location for assessment and recommendations. RPM is covered for both acute and chronic conditions.

SOURCE: Medical Services Administration (MSA) Bulletin 21-24 Aug. 2021. (Accessed Nov. 2022).


CONDITIONS

RPM devices include (1) non-invasive remote monitoring devices that measure or detect common physiological parameters, and (2) non-invasive monitoring devices that wirelessly transmit the beneficiary’s medical information to their health care provider or other monitoring entity. The device must be reliable and valid, and the beneficiary must be trained or sufficiently knowledgeable in the proper use/wearing of the device to ensure appropriate recording of medical information. Medical information may include, but is not limited to, blood pressure and heart rate and rhythm monitoring.

SOURCE: Medical Services Administration (MSA) Bulletin 21-24 Aug. 2021. (Accessed Nov. 2022).


PROVIDER LIMITATIONS

No Reference Found


OTHER RESTRICTIONS

All RPM devices, including mobile medical applications, must meet the U.S. Food & Drug Administration (FDA) definition of a medical device. Personal tablets, computers, cell phones, software intended for administrative support or support of healthy lifestyles/general wellness, and electronic health records are not medical devices or durable medical equipment and are not covered as part of RPM services.

Reimbursement for the device used for remote monitoring, and programming of the device, is generally included in the reimbursement of RPM services and not separately reimbursable. For items or devices separately reimbursed to a medical supplier, such as personal use continuous glucose monitoring systems (CGMs), refer to the Medical Supplier chapter of the MDHHS Medicaid Provider Manual.

SOURCE: Medical Services Administration (MSA) Bulletin 21-24 Aug. 2021. (Accessed Nov. 2022).

Last updated 11/22/2022

Store and Forward

POLICY

Telecommunication systems using store-and-forward technology are not included in MI Medicaid’s telemedicine policy.

SOURCE: Dept. of Health and Human Services, Medicaid Provider Manual, p. 1886, Oct. 1, 2022 (Accessed Nov. 2022).

Asynchronous telemedicine services include the transmission of a beneficiary’s medical or other personally identifiable information through a secure, Health Insurance Portability and Accountability Act (HIPAA)-compliant, electronic communications system to a provider, often a specialist, at a distant site without the beneficiary present. Such communications, including store and forward services, interprofessional telephone/Internet/electronic health record consultations, and RPM services, involve contact between two parties (beneficiary to provider or provider to provider) in a way that does not require real-time interaction. Services must be medically necessary or essential for behavioral health and part of a provider-directed treatment plan.

Photographs visualized by a telecommunications system must be specific to the beneficiary’s physical and/or behavioral health condition and adequate for furnishing or confirming a diagnosis and/or treatment plan.

In accordance with Section 16284 of Public Act No. 359 of 2016, telemedicine services, including asynchronous telemedicine, must be provided only with direct or indirect beneficiary consent and this consent must be properly documented in the beneficiary’s medical record in accordance with applicable standards of practice.

Interprofessional telephone/Internet/electronic health record consultations, including e-Consults, are a type of asynchronous telemedicine service in which the beneficiary’s Medicaid-enrolled treating physician (e.g., attending or primary) or practitioner requests the opinion and/or treatment advice of a Medicaid enrolled physician or practitioner with the specialty expertise to assist in the diagnosis of a condition and/or management of the beneficiary’s condition without beneficiary face-to-face contact with the consultant. The service concludes with a written report from the consultant to the treating physician/requesting provider.

SOURCE: Medical Services Administration (MSA) Bulletin 21-24 Aug. 2021. (Accessed Nov. 2022)


ELIGIBLE SERVICES/SPECIALTIES

Services must be medically necessary or essential for behavioral health and part of a provider-directed treatment plan.  Asynchronous telemedicine services must be performed under the general or direct supervision of a Medicaid-enrolled physician or practitioner who has an active role in the management of the beneficiary’s physical and/or behavioral health. The analysis and interpretation of the beneficiary’s data must contribute to the development and/or monitoring of the beneficiary’s treatment plan.

Asynchronous telemedicine services generally may not be separately reported on the same day the beneficiary presents for an evaluation and management (E/M) or other related service to the same provider. These services are typically considered part of the E/M or other related service and are not separately reimbursed. Activities performed in the facility setting under the general or direct supervision of the provider are bundled with the facility services on the UB-04 claim form and cannot be reported on the CMS 1500 claim form or billed under the provider’s National Provider Identifier (NPI).

Store and forward services are asynchronous electronic transmissions of physical and/or behavioral health information from the beneficiary to a Medicaid-enrolled physician or practitioner at the distant site when video or face-to-face contact is not necessary. Information transmitted to the provider is analyzed and used in the diagnosis, development, or maintenance of an individualized treatment plan. Information may include, but is not limited to, digital images, documents, video clips, still images, x-rays, magnetic resonance images (MRIs), electrocardiograms (EKGs) and electroencephalograms (EEGs), and audio clips.

Store and forward services include interpretation and follow-up with the beneficiary. Services must not originate from or result in a related E/M service.

SOURCE: Medical Services Administration (MSA) Bulletin 21-24 Aug. 2021. (Accessed Nov. 2022)


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

Last updated 11/22/2022

Cross State Licensing

In limited circumstances, MI Public Health Code states that certain individuals are not required to have a license for practice of a health profession in MI, including the following:
  • A student who is in a health profession training program, that has been approved by the appropriate board, while performing the duties assigned in the course of training.
  • An individual who is practicing a health profession in the discharge of official duties while in the military service of the United States, the United States Public Health Service, the United States Department of Agriculture, or the United States Department of Veterans Affairs. The institution in which the individual practices shall report the name and address of the individual to the appropriate board within 30 days after the date of employment.
  •  An individual who by education, training, or experience substantially meets the requirements of this article for licensure while rendering medical care in a time of disaster or to an ill or injured individual at the scene of an emergency.
  • If the director of the department of health and human services determines that control of an epidemic is necessary to protect the public health under section 2253, an individual who is authorized to practice a health profession in another state, who would otherwise meet the requirements of this article for licensure, while rendering medical care during an epidemic-related staffing shortage to meet health professional staffing needs. As used in this subdivision, “epidemic-related staffing shortage” means a shortage of individuals who are licensed under this article during the epidemic. Epidemic-staffing shortage does not include a staffing shortage caused by a labor dispute as that term is defined in section 2 of 1939 PA 176, MCL 423.2.
  • An individual who provides nonmedical nursing or similar services in the care of the ill or suffering or an individual who in good faith ministers to the ill or suffering by spiritual means alone, through prayer, in the exercise of a religious freedom, and who does not hold himself or herself out to be a health professional.
  • An individual who resides in another state or country and is authorized to practice a health profession in that state or country who, in an exceptional circumstance, is called in for consultation or treatment by a health professional in this state.
  • An individual who resides in another state or country and is authorized to practice a health profession in that state or country, when attending meetings or conducting lectures, seminars, or demonstrations under the auspices of professional associations or training institutions in this state, if the individual does not maintain an office or designate a place to meet patients or receive calls in this state.
  • An individual who is authorized in another country to practice a health profession and who is employed by the United States Public Health Service or the government of another country for the exclusive use of members of its merchant marine and members of its consular and diplomatic corps, while caring for those members in the performance of his or her official duties.
  • An individual who resides adjacent to the land border between this state and an adjoining state and is authorized under the laws of that state to practice a health profession and whose practice may extend into this state, but who does not maintain an office or designate a place to meet patients or receive calls in this state.
  • An individual who is authorized to practice a health profession in another state and who is appointed by the United States Olympic Committee to provide health services exclusively to team personnel and athletes registered to train and compete at a training site in this state approved by the United States Olympic Committee or at an event conducted under the sanction of the United States Olympic Committee. An exemption granted under this subdivision applies to the individual while he or she is performing the duties assigned in the course of the sanctioned training program or event and for the time period specified by the United States Olympic Committee.
  • An individual who is currently authorized to practice a health profession in another state and is providing health services for an athletic team, if certain criteria are met.

SOURCE: MI Public Health Code 333.16171. License for practice of health profession; exemptions. Accessed Nov. 2022.

Last updated 11/22/2022

Definitions

“Telehealth” means the use of electronic information and telecommunication technologies to support or promote long-distance clinical health care, patient and professional health-related education, public health, or health administration. Telehealth may include, but is not limited to, telemedicine. As used in this subdivision, “telemedicine” means that term as defined in section 3476 of the insurance code of 1956, 1956 PA 218, MCL 500.3476.

“Telemedicine” means the use of an electronic media to link patients with health care professionals in different locations. To be considered telemedicine under this section, the health care professional must be able to examine the patient via a health insurance portability and accountability act of 1996, Public Law 104-191 compliant, secure interactive audio or video, or both, telecommunications system, or through the use of store and forward online messaging.

SOURCE:  MI Compiled Laws Sec. 333.16283(c),   MI Insurance Code 500.3476.  & MI Compiled Laws Sec. 330.1100d(16). (Accessed Nov. 2022).

Last updated 11/22/2022

Licensure Compacts

Member of Interstate Medical Licensure Compact.

SOURCE: Interstate Medical Licensure Compact, Compact Map. (Accessed Nov. 2022).

* See Compact websites for implementation and license issuing status and other related requirements.

Last updated 11/22/2022

Miscellaneous

In a manner consistent with this part and in addition to the provisions set forth in this part, a disciplinary subcommittee may place restrictions or conditions on a health professional’s ability to provide a telehealth service if the disciplinary subcommittee finds that the health professional has violated section 16284 or 16285.

SOURCE: MI Compiled Law Section 333.16286 (Accessed Nov. 2022).

Last updated 11/22/2022

Online Prescribing

Providers must have an existing physician-patient or dentist-patient relationship.  See statute for additional requirements.

SOURCE: MI Compiled Laws Sec. 333.17751(2)(a).  (Accessed Nov. 2022).

Schedule 2 to 5 controlled substances cannot be prescribed unless the prescribing is in a bona fide prescriber-patient relationship with the patient.  If a licensed prescriber prescribes a controlled substance under this subsection, the prescriber shall provide follow-up care to the patient to monitor the efficacy of the use of the controlled substance as a treatment of the patient’s medical condition. If the licensed prescriber is unable to provide follow-up care, he or she shall refer the patient to the patient’s primary care provider for follow-up care or, if the patient does not have a primary care provider, he or she shall refer the patient to another licensed prescriber who is geographically accessible to the patient for follow-up care.

SOURCE:  MI Compiled Laws Sec. 333.7303a. (Accessed Nov. 2022). 

A health professional providing telehealth service to a patient may prescribe the patient a drug if both the following are met:

  • The health professional is a prescriber who is acting within the scope of his or her practice; and
  • If the health professional is prescribing a controlled substance, the health professional must meet the requirements of this act applicable to that health professional for prescribing a controlled substance.

If the health professional considers it medically necessary, he or she shall provide the patient with a referral for other health care services that are geographically accessible to the patient, including, but not limited to, emergency services. After providing a telehealth service, the health professional, or a health professional who is acting under the delegation of the delegating health professional, shall make himself or herself available to provide follow-up health care services to the patient or refer the patient to another health professional for follow-up health care services.

SOURCE:  MI Compiled Laws, Sec. 333.16285. (Accessed Nov. 2022).

Genetic Counseling, Optometry, Medicine, Podiatric Medicine & Surgery

A licensee providing a telehealth service may prescribe a drug if the licensee is a prescriber acting within the scope of his or her practice and in compliance with section 16285 of the code, MCL 333.16285, and if he or she does both of the following:

If medically necessary, refers the patient to a provider that is geographically accessible to the patient.

Makes himself or herself available to provide follow-up care services to the patient, or to refer the patient to another provider, for follow-up care.

A licensee providing any telehealth service shall do both of the following:

  • Act within the scope of his or her practice.
  • Exercise the same standard of care applicable to a traditional, in-person health care service.

SOURCE: MI Administrative Code 338.2455. MI Administrative Code 338.306, MI Administrative Code 338.2407, & MI Administrative Code 338.8145, (Accessed Nov. 2022).

Last updated 11/22/2022

Definition of Visit

An allowable FQHC encounter means a face-to-face medical visit between a patient and the provider of health care services who exercises independent judgment in the provision of health care services. Encounters may be classified as medical, dental, or behavioral health.

An encounter occurs between a medical provider and a patient when medical services are provided for the prevention, diagnosis, treatment, or rehabilitation of an illness or injury. Included in this category are physician visits and mid-level practitioner visits. Family planning medical visits are a subset of medical visits.

SOURCE: Dept. of Health and Human Services Medicaid Provider Manual, p. 740, Oct. 1, 2022 (Accessed Nov. 2022). 

Last updated 11/22/2022

Eligible Distant Site

A Tribal facility may choose to enroll as a Tribal FQHC and be reimbursed for outpatient face-to-face visits within the FQHC scope of services provided to Medicaid beneficiaries, including telemedicine and services provided by contracted employees. Tribal FQHCs are eligible to receive the IHS outpatient AIR for eligible encounters.

SOURCE: Dept. of Health and Human Services Medicaid Provider Manual, p. 2122, Oct. 1, 2022 (Accessed Nov. 2022). 

An FQHC can be either an originating or distant site for telemedicine services.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 738, Oct. 1, 2022 (Accessed Nov. 2022). 

See: MI Medicaid Live Video Distant Site

Last updated 11/22/2022

Eligible Originating Site

An FQHC can be either an originating or distant site for telemedicine services.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 738, Oct. 1, 2022 (Accessed Nov. 2022). 

The following are authorized as originating sites for telemedicine services:

  • Federally Qualified Health Center (FQHC)

SOURCE: Dept. of Health and Human Services Medicaid Provider Manual, p. 1887, Oct. 1, 2022 (Accessed Nov. 2022). 

See: MI Medicaid Live Video Eligible Sites.

Last updated 11/22/2022

Facility Fee

To be reimbursed for the originating site facility fee, the originating site provider must bill the appropriate telemedicine procedure code and modifier. MDHHS will reimburse the originating site provider the lesser of charge or the current Medicaid fee screen.

SOURCE: Dept. of Health and Human Services, Medicaid Provider Manual, p. 268, Oct. 1, 2022 (Accessed Nov. 2022).

FQHCS are eligible originating sites.

See: MI Medicaid Live Video Facility/Transmission Fee

Last updated 11/22/2022

Home Eligible

Off-site services provided by employed practitioners of the FQHC to beneficiaries temporarily homebound or in any assisted living or skilled nursing facility because of a medical condition that prevents the beneficiary from traveling to the FQHC are also allowable for reimbursement under the PPS or the MOU.

SOURCE: Dept. of Health and Human Services Medicaid Provider Manual, p. 736-737, Oct. 1, 2022 (Accessed Nov. 2022). 

Last updated 11/22/2022

Modalities Allowed

Live Video

An FQHC, can be either an originating or distant site for telemedicine services.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 738, Oct. 1, 2022 (Accessed Nov. 2022). 

See: MI Medicaid Live Video.


Store and Forward

Asynchronous telemedicine services are allowed in specific situations, however, CCHP has not found an explicit reference  stating whether or not FQHCs can be reimbursed in Medicaid manuals.

See: MI Medicaid Store and Forward.


Remote Patient Monitoring

According to the MI Medicaid provider manual, RPM is covered with restrictions, however there is no indication from Medicaid if FQHCs can bill for this.

See: MI Medicaid Remote Patient Monitoring.


Audio-Only

MDHHS will require modifier FQ to be appended in addition to modifier GT. When a provider submits modifier FQ for an audio only service, the provider does not need to include a note in the remarks section stating that the service was provided via telephone (per bulletin MSA 20-13). Please note, modifier GT must be included for the claim to be processed correctly. For FQHCs/RHCs/THCs and Tribal FQHCs, please use modifier GT and modifier FQ as indicated above.

Further updates to telemedicine reporting will be provided in future bulletins.

SOURCE: MI Health and Aging Services Administration Bulletin HASA 22-03 (Feb. 8, 2022), (Accessed Nov. 2022).

See: MI Medicaid Email, Phone and Fax.

 

Last updated 11/22/2022

Patient-Provider Relationship

No reference found

Last updated 11/22/2022

PPS Rate

A Tribal facility may choose to enroll as a Tribal FQHC and be reimbursed for outpatient face-to-face visits within the FQHC scope of services provided to Medicaid beneficiaries, including telemedicine and services provided by contracted employees. Tribal FQHCs are eligible to receive the IHS outpatient AIR for eligible encounters.

SOURCE: Dept. of Health and Human Services Medicaid Provider Manual, p. 2122, Oct. 1, 2022 (Accessed Nov. 2022). 

Last updated 11/22/2022

Same Day Encounters

An FQHC may be credited with one encounter for each different type of visit provided to a beneficiary during a single day, regardless of the number of services provided at the visit. A maximum of three encounters are allowed per beneficiary per day (one medical, one dental, and one behavioral health). In cases where the beneficiary, after the first visit, suffers illness or injury requiring additional diagnosis or treatment, these visits may be classified as two encounters.

SOURCE: Dept. of Health and Human Services Medicaid Provider Manual, p. 741, Oct. 1, 2022 (Accessed Nov. 2022).