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Bulletin Number:Distribution:Issued:Subject:Effective:MSA 21-03All ProvidersFebruary 17, 2021Current Procedural Terminology (CPT) and Healthcare CommonProcedure Coding System (HCPCS) Code UpdatesAs IndicatedPrograms Affected: Medicaid, Healthy Michigan Plan, Children’s Special Health CareServices, Maternity Outpatient Medical ServicesThis bulletin is to notify you of Current Procedural Terminology (CPT) and Healthcare CommonProcedure Coding System (HCPCS) changes being implemented by the Michigan Departmentof Health and Human Services (MDHHS). Effective dates are identified for each topic area.Please note that this notice is distributed to a broad range of providers and not all, or any, ofthe codes listed may apply to your scope of practice.Refer to HCPCS code books and the Centers for Medicare & Medicaid Services (CMS)website (www.cms.hhs.gov) for full descriptions of codes. Information regarding fee screens ismaintained on the appropriate database or professional fee schedule on the MDHHS websiteat www.michigan.gov/medicaidproviders Billing and Reimbursement Provider SpecificInformation. Additional pertinent coverage parameters, such as age restrictions, priorauthorization requirements, and other billing indicators, are accessible via the Medicaid Codeand Rate Reference tool within CHAMPS at https://sso.state.mi.us External Links Medicaid Code and Rate Reference.A.JANUARY 1, 2021 ANNUAL HEALTHCARE COMMON PROCEDURE CODINGSYSTEM (HCPCS) CODE UPDATESListed below are HCPCS codes being adopted by MDHHS for dates of service on andafter January 1, 2021 and the provider groups allowed to bill these codes. Any newprocedure code not listed will not be covered at this time, except for reporting codes.Coding information is based on the most recent file from CMS. If additional coderevisions are released by CMS, a subsequent bulletin will be published notifying providersof this change.The symbol * will appear with those codes requiring prior authorization (PA).
MSA 21-03Page 2 of 9HCPCS 2021 reporting codes (Category II codes and other select HCPCS codes) will beallowed for submission to Medicaid where appropriate. The codes are optional but can beused to complement Category I codes for clarification purposes. Reporting codes will notappear on the MDHHS fee schedule; however, a full list of current codes can be found atwww.ama-assn.org/go/cpt.1.Physicians, Practitioners, and Medical 265393247G2213J9144*Outpatient Prospective Payment System (OPPS)/Ambulatory PaymentClassification (APC)MDHHS aligns with Medicare guidelines for procedure codes covered through theOPPS/APC as closely as possible. Certain procedures billed by OutpatientHospitals, Comprehensive Outpatient Rehabilitation Facilities, RehabilitationAgencies, and Freestanding Dialysis Centers may represent packaged/bundledservice codes. The costs for these services are allocated to the APC but are not paidseparately. For services not paid under OPPS, MDHHS will utilize a Medicare feeschedule with the MDHHS reduction factor applied.a.Wrap Around CodesCodes covered differently than Medicare or specific to Michigan Medicaidservices will be identified on the January 2021 version of the OPPS WrapAround Code List on the MDHHS website:www.michigan.gov/medicaidproviders Billing and Reimbursement ProviderSpecific Information Outpatient Hospitals
MSA 21-03Page 3 of 93.Ambulatory Surgical Centers (ASC)MDHHS aligns with Medicare guidelines for Medicaid covered procedure codescovered through the Outpatient Ambulatory Prospective Payment System (OAPPS)as closely as possible. Certain procedures billed by ASCs may representpackaged/bundled service codes. The costs for these services are not paidseparately. For ASC services paid as Medicare-certified ASC facilities, MDHHS willutilize a Medicare fee schedule with the MDHHS reduction factor applied.a.Wrap Around CodesCodes covered differently than Medicare or specific to Michigan Medicaidservices will be identified on the January 2021 version of the ASC Code List onthe MDHHS website: www.michigan.gov/medicaidproviders Billing andReimbursement Provider Specific Information Ambulatory SurgicalCenters4.Oral/Maxillofacial 192*81347*81419*8018981193*81348*81513School Based ServicesG22509.92518Urgent Care 994176.99417G2251Laboratory *81352*81546*
MSA 21-03Page 4 of 910. Social Worker, Psychologist, Professional Counselor and Marriage and FamilyTherapistsG2250G225111. CORF/CARF/Rehab Agency9265092651926529265312. CAA-Accredited Univ Grad Ed 17G221213. Hospice99417G221214. Certified Nurse Midwife57465U000581513G2212G2252932459324615. Family Planning Clinic574658151316. Independent Diagnostic Testing . Physical, Occupational and Speech TherapyG2250G225118. Federally Qualified Health Centers, Rural Health Clinics and Tribal 005
MSA 21-03Page 5 of 919. Local Health 903779941799417G221220. Child and Adolescent Health Centers & Programs81513U0005B.81514820778268190377NEW COVERAGE OF EXISTING CODESEffective for dates of service on and after January 1, 2021, existing HCPCS codes will beactivated for coverage as identified in the following provider categories:1. Physicians, Practitioners, and Medical Clinics95705957089571195714994842. Local Health Department, Child and Adolescent Health Centers & Programs,Federally Qualified Health Center, Rural Health Clinic, Tribal Health Center994843. School Based Services994844. Laboratory Services81415*81416*81417*0037U*5. Independent Diagnostic Testing Facility95705C.957089571195714RETROACTIVE COVERAGE OF EXISTING CODES1.Physicians, Practitioners, and Medical Clinicsa. Effective for dates of service on and after October 1, 2020, MDHHS will cover thefollowing HCPCS codes:J1437J9304J1632J1738J3032J3241J7351J9227
MSA 21-03Page 6 of 9b. Effective for dates of service on and after November 10, 2020, MDHHS will coverthe following HCPCS codes:M0239Q0239c. Effective for dates of service on and after November 21, 2020, MDHHS will coverthe following HCPCS codes:M02432.Q0243Federally Qualified Health Centers, Rural Health Clinics and Tribal HealthCentersa. Effective for dates of service on and after October 1, 2020, MDHHS will cover thefollowing HCPCS code:J9227b. Effective for dates of service on and after November 10, 2020, MDHHS will coverthe following HCPCS codes:M0239Q0239c. Effective for dates of service on and after November 21, 2020, MDHHS will coverthe following HCPCS codes:M02433.Q0243Physicians, Practitioners, Medical Clinics, Certified Nurse Midwives, LocalHealth Departments, Child and Adolescent Health Centers and Programs,Federally Qualified Health Centers, Rural Health Clinics, Tribal HealthCenters, Urgent Care Centers and Laboratory Servicesa. Effective for dates of service on and after August 10, 2020, MDHHS will cover thefollowing HCPCS codes:8640886409b. Effective for dates of service on and after September 8, 2020, MDHHS will coverthe following HCPCS code:86413
MSA 21-03Page 7 of 9c. Effective for dates of service on and after October 6, 2020, MDHHS will cover thefollowing HCPCS codes:876368763787811d. Effective for dates of service on and after November 10, 2020, MDHHS will coverthe following HCPCS code:87428D.RETROACTIVE COVERAGE OF MODIFIERSEffective for dates of service on and after October 1, 2020, MDHHS will cover thefollowing Modifiers:J5E.V4OFFICE AND OUTPATIENT EVALUATION AND MANAGEMENTEffective for dates of service on and after January 1, 2021, Michigan Medicaid will alignwith the 2021 American Medical Association (AMA) CPT coding guidelines for theselection of level of office or other outpatient Evaluation and Management Services (E/M)as represented by CPTs 99202-99215. Practitioners may select the appropriate level ofE/M service based on the following: The level of the medical decision making as defined for each service; orThe total time for E/M services performed on the date of the encounter.The process for determining the level of service in the remaining categories of E/Mservices remains unchanged.F.COVID-19 SPECIMEN COLLECTION BILLING UPDATEConsistent with public health emergency conditions related to COVID-19, to supportwidespread COVID–19 testing, Medicaid will temporarily reimburse COVID-19 specimencollection as specified in policy bulletins MSA 20-57 and MSA 20-74. Practitioners,Pharmacists, Federally Qualified Health Centers, Rural Health Clinics, Tribal HealthCenters, and Tribal Federally Qualified Health Centers may bill for COVID-19 specimencollection services for date of service on or after March 10, 2020 using procedure code99000 or 99001 and either ICD-10-CM diagnosis code Z03.818, Z11.59, or Z20.828 asappropriate.The Centers for Disease Control and Prevention’s (CDC) National Center for HealthStatistics (NCHS) has released a January ICD-10-CM code update which includes twonew diagnosis for reporting COVID-19 screening and suspected exposure to COVID-19.
MSA 21-03Page 8 of 9As a result, Medicaid is requesting providers discontinue reporting diagnosis Z03.818,Z11.59, or Z20.828 on Medicaid COVID-19 specimen collection claims for dates ofservice after February 28, 2021. Services billed with these diagnoses after this date willno longer be eligible for Medicaid reimbursement.Effective for dates of service on or after March 1, 2021, COVID-19 specimen collectionservices must be reported using procedure code 99000 or 99001 and one of the new2021 diagnosis codes listed below: Z20.822 - Contact with and (suspected) exposure to COVID-19Z11.52 - Encounter for screening for COVID-19As a reminder, COVID-19 specimen collection is reimbursed as a separate service onlywhen no other evaluation and management service or eligible qualifying clinic visit relatedto COVID-19 testing is provided on the same date of service.G.RETROACTIVE COVERAGE OF PLACE OF SERVICE (POS) CODESEffective for claims processed on or after October 1, 2020, the following POS will berecognized: 60 - Mass Immunization Center.H.PRIOR AUTHORIZATION FOR EXISTING CODEEffective for dates of service on and after January 1, 2021, the following HCPCS code willrequire prior authorization:81539I.DISCONTINUED HCPCS PROCEDURE CODES FOR ALL APPLICABLE PROVIDERTYPESThe following HCPCS codes are discontinued effective December 31, G2119G2134G2159G8398G8628
MSA 21-03Page 9 of 8G9850G9935M1033M1137The following HCPCS codes are discontinued effective September 30, 2020:C9055C9059C9061C9063QuestionsAny questions regarding this bulletin should be directed to Provider Inquiry, Department ofHealth and Human Services, P.O. Box 30731, Lansing, Michigan 48909-8231, or e-mailed toProviderSupport@michigan.gov. When you submit an e-mail, be sure to include your name,affiliation, NPI number, and phone number so you may be contacted if necessary. Providersmay phone toll-free 1-800-292-2550.ApprovedKate Massey, DirectorMedical Services Administration
authorization requirements, and other billing indicators, are accessible via the Medicaid Code and Rate Reference tool within CHAMPS at https://sso.state.mi.us External Links Medicaid Code and Rate Reference. A. JANUARY 1, 2021 ANNUAL HEALT
