michigan addiction treatment medicaid billing

In today’s post, we’ll cover some of the most frequently asked questions about billing Medicaid for addiction treatment in Michigan.

What is Michigan’s Medicaid program called?

The most common name of Michigan Medicaid is simply Medicaid. However, there are some circumstances where you’ll hear Medicaid plan names such as Healthy Michigan Plan, Children’s Special Health Care Services, MIChild, or Maternity Outpatient Medical Services. All of these programs are administered by the Michigan Department of Health and Human Services.

What’s the best place to find information about addiction treatment billing for Medicaid in Michigan?

michigan medicaid addiction treatment information resources

The Department of Health and Human Services in Michigan hosts a number of extremely helpful documents on their website. You can find most of them here.

What are some of the most common CPT codes used in addiction treatment Medicaid billing in Michigan?

Here’s a list of the most commonly used CPT codes for addiction treatment in Michigan, all of which are billable to Medicaid. You can consult the entire list on Michigan’s Behavioral Health Code Charts and Provider Qualifications spreadsheet.

80305/80306/80307 Substance Use Disorder: Laboratory Tests

90785 Substance Abuse: Outpatient Care

90832 30 minutes of Psychotherapy for Substance Abuse in the context of Outpatient Care

90834:Outpatient Interactive individual psychotherapy

90837: Psychotherapy, 60 minutes with individual and/or family member

Family psychotherapy (without patient present), per session

90847 Substance Abuse: Outpatient Care

90847: Family psychotherapy (conjoint psychotherapy) (with patient present)

90849: Family psychotherapy

90853: Interactive group psychotherapy

99202: Evaluation and Management of New Patient - total encounter no more than 30-44 minutes long

99204 Evaluation and Management of New Patient - total encounter no more than 45-59 long

99205 Evaluation and Management of New Patient - total encounter no more than 60-74 minutes long

A0100 Transportation - taxi

A0110 Transportation - bus

G01409 - Outpatient Care Recovery Support Services - social work and psychological services

G2067 - Methadone

G2068 - Buprenorphine

G2073 - Naltrexone

G2076 - MAT Intake Activities

G2077 - MAT Periodic Assessment

G2078 - MAT methadone takehome

G2079 - MAT Buprenorphine takehome

G2080 - MAT counseling

H0001 - Individual assessment

H0003 - UAs

H0004 - Outpatient behavioral health counseling, per 15 minutes of care

H0005 - group counseling, 15 minutes of care

H0006 - Case management

H0010 - Sub acute withdrawal management

H0018 - Residential services

H0038 - Recovery support services recovery coach, peer services, per 15 minutes of care

H0038/WT - Youth peer support specialists, per 15 minutes of care

H0050 - outpatient, brief intervention, per 15 minutes

H2011 - outpatient, crisis intervention

H2027 - outpatient, didactics

H2034 - recovery housing, per diem

S9976 - Residential room and board

T1007 - outpatient care, treatment planning

T1009 - child sitting servives

T1012 - Substance abuse, outpatient care, recovery supports

What treatment services are billable to Michigan’s Medicaid program?

michigan department of health and human services medicaid provider manual

Michigan names several categories of care - also known as levels of care - in its covered services list, which you can locate in Michigan’s Medicaid Provider Manual. They include:

MAT or medication assisted treatment

Outpatient treatment
Sub-acute detoxification treatment
Residential treatment

State of Michigan, Department of Health and Human Services SFY 2022 Behavioral Health Code Sets, Charts, and Provider Qualifications Qualifications and Encounter Reporting HCPCS and Revenue Codes

Does Michigan Medicaid cover peer recovery support?

Yes. According to the Medicaid Provider Manual, peer recovery coaches are covered in Michigan. There are some rules regarding who can provide this care. All peer recovery coaches need to be under the supervision of a SATS (Substance Abuse Treatment Specialist) or a SATP (Substance Abuse Block Grant). SABG programs must place all peer recovery coaches under the supervision of a case manager, treatment practitioner, prevention staff, or Certified Peer Recovery Coach. In Michigan, a Certified Peer Recovery Coach must have at least two consecutive years of sobriety and they must also have at least two years of experience providing coaching services.

What services are excluded from Michigan Medicaid for addiction treatment?

michigan excluded medicaid billing addiction treatment exclusions

While Michigan’s medicaid program does cover addiction treatment services, there are many aspects of care that are not covered. Excluded services include:

Room and board
Unspecified services (services that aren’t specifically mentioned in the Covered or Allowable Services)
Acute detoxification
Lab services that aren’t methadone-related
Medications
Emergency medical care
Emergency transport services
Prevention and treatment work that occurs in routine PCP appointments
Transport that could otherwise be arranged by MDHHS

Does Michgian’s Medicaid program cover sober living homes or recovery residences?

No. Michigan Medicaid specifically states that “room and board” are excluded from coverage. Although ASAM has embraced sober living as an important piece of recovery, the new ASAM Criteria still does not include sober living homes as an official part of the continuum of care that should be normatively covered by public health insurance.

Master Medicaid Billing for Addiction Treatment in Michigan