Updates to Billing Configurations and Recoupment Project
March 18, 2025
The Michigan Department of Health and Human Services (MDHHS) has made updates to billing configurations to ensure proper claim adjudication and prevent payment errors. Please review the following changes that may impact your reimbursements.
1. Anesthesia Services (Effective 1/1/21)
Anesthesia services were previously configured incorrectly, resulting in certain non-covered services being paid in error. The configuration has been updated to align with the MDHHS Anesthesia Fee Schedule. Claims that should deny as non-covered are now processing correctly.
2. Chiropractic Services (Effective 1/1/21)
Providers billing under Chiropractic Specialty 35 must adhere to the MDHHS published Chiropractic Fee Schedule. Any services billed outside of the approved schedule will result in the following denial:
- EXZC – Deny: Provider Not Contracted for the Service Provided
- Per MDHHS policy, chiropractors are reimbursed only for services outlined in the Chiropractic Fee Schedule
3. PT/OT/ST Therapy Services for F84.0 Diagnosis (Effective 6/1/24)
Physical Therapy (PT), Occupational Therapy (OT), and Speech Therapy (ST) services billed on claims with diagnosis code of F84.0 (autism spectrum disorder) will now be denied with the following code:
- EXMW – Please Submit Services to Behavioral Health Vendor
- This change aligns with MDHHS guidance outlined in L 24-32, released on May 14th, 2024