Michigan Medicaid Telemedicine Billing

Last updated: July 6, 2026.

Bottom line: Michigan Medicaid does pay for telehealth therapy, but the modality changes how you code the claim. As a rule of thumb you must confirm before billing: synchronous audio-visual (real-time video + audio) sessions have historically carried modifier 95, and synchronous audio-only (telephone) sessions have historically carried modifier 93. Michigan Medicaid's fee-for-service guidance has also pointed providers to report the place of service as if the visit were in person rather than a generic telehealth POS — different from Medicare and some commercial plans. None of this is safe to assume from memory: codes get added and deleted, modifier and POS rules shift, and managed care plans add their own requirements. Before you submit a telehealth claim, verify the specifics in the current MDHHS Telemedicine policy (bulletin MMP 23-10), the Telemedicine chapter of the Medicaid Provider Manual, and the current telemedicine fee schedules — and check the rules of whichever payer actually covers your client (MDHHS fee-for-service, a Medicaid Health Plan, or a PIHP/CMHSP).

Telehealth is now routine in most therapy practices, and Michigan Medicaid supports it. The catch is operational: the state's telemedicine policy is coded and modifier-driven, the code sets changed recently, and the "right" way to bill depends on the modality and on who is paying. Get the modifier, place of service, or code wrong and the claim denies — even when the service was appropriate. This guide shows how to verify the current rules rather than guess. Treat every code, modifier, and POS statement below as "confirm in current MDHHS policy before you bill."

Start here: which Michigan Medicaid sources actually control

MDHHS publishes a Telemedicine billing and reimbursement page, but that page is explicitly a reference — its own language tells providers to use it in conjunction with the Billing & Reimbursement chapters of the Medicaid Provider Manual, the Medicaid Code and Rate Reference tool, and the related fee schedules. When the quick reference and the Manual/bulletins disagree, the Provider Manual and Medicaid Policy (MMP) bulletins win.

The documents you want open when you build a telehealth claim:

• The MDHHS Telemedicine billing/reimbursement page — your starting map and links to the current fee schedule files.

• MMP bulletin 23-10 (Telemedicine) — the current telemedicine policy bulletin, with a section specifically on Place of Service, modifier 95, and modifier 93. Check for any newer bulletin that supersedes it.

• The Telemedicine chapter of the Medicaid Provider Manual, plus the Billing & Reimbursement for Professionals chapter — the controlling policy detail.

• The current telemedicine fee schedule files (audio-visual and audio-only) and the Code and Rate Reference tool — to confirm a specific code is telehealth-eligible.

• Your payer's rules — an MHP or PIHP/CMHSP may add its own requirements.

Skim only the reference page and skip the Manual, bulletin, and fee schedule, and you are billing on assumptions.

Audio-visual vs. audio-only: they are not the same claim

Michigan Medicaid distinguishes synchronous audio-visual telemedicine (a real-time, two-way video-and-audio session) from synchronous audio-only telemedicine (a real-time telephone session with no video). The distinction matters for both coding and coverage. A few things to hold onto:

• Audio-visual is the default expectation for most services. Live video most closely mirrors an in-person session and is broadly supported.

• Audio-only is covered, but conditionally — do not assume it is always payable. Current Michigan Medicaid guidance frames audio-only as appropriate when the client cannot reasonably access a video platform and when the service does not require visual assessment, offered at the client's preference rather than the provider's convenience. Some services cannot be billed audio-only. Confirm eligibility for your specific service first.

• The code you report can differ by modality. The national code landscape changed recently — the older audio-only telephone codes (99441–99443) were deleted effective January 1, 2025, and new telemedicine E/M code families were introduced. Re-verify your codes each year rather than reusing last year's cheat sheet.

For therapists, most sessions are psychotherapy codes rather than E/M codes, but the principle holds: confirm each CPT/HCPCS code you bill is on the current telehealth-eligible list for the modality you used.

Modifier 95 and modifier 93: what to verify

Here is the historical convention that has held in Michigan Medicaid and across most payers — stated as something to confirm, not a promise:

• Modifier 95 — "synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system." Used for audio-visual telehealth.

• Modifier 93 — "synchronous telemedicine service rendered via telephone or other real-time interactive audio-only telecommunications system." Used for audio-only telehealth.

Current MDHHS telemedicine policy has stated that telemedicine claims must include the corresponding modifier (95 for audio-visual, 93 for audio-only). A few practical notes:

• The old "GT" modifier is legacy. Michigan Medicaid moved to the 95/93 convention; do not assume GT still works.

• Modifier choice must match the actual modality. A telephone session takes the audio-only modifier (93) — you cannot bill it as though it were video. Mismatches are a common, avoidable denial.

• Individual plans may want different modifiers. A Medicaid Health Plan may accept or require a different set than MDHHS fee-for-service. Check the plan.

Because modifier policy changes often, treat 95/93 as the current convention to verify in MMP 23-10 and the Telemedicine chapter, not a permanent fact.

Place of service and documentation: do not copy Medicare habits

Place of service (POS) trips up a lot of therapists who bill multiple payers, because Michigan Medicaid fee-for-service has not necessarily followed the Medicare pattern.

Medicare and many commercial plans want a telehealth-specific POS — POS 02 (telehealth outside the patient's home) or POS 10 (telehealth in the patient's home). Michigan Medicaid's fee-for-service telemedicine guidance, by contrast, has pointed providers to report the place of service as they would if the service were in person, letting the modifier (95 or 93) signal that the encounter was telehealth. Reflexively stamping POS 02 on a Michigan Medicaid FFS claim because that is what you do for Medicare can cause a denial.

Confirm the nuance for your situation: fee-for-service professional claims have used the in-person POS + telehealth modifier approach; PIHP/CMHSP encounter reporting for specialty behavioral health can use POS 02 or 10 with the modality modifier; and Medicaid Health Plans may follow their own POS instructions. So the honest answer to "POS 02 or the in-person POS?" is: it depends on the payer/route, and you must verify. Do not hard-code one POS across all your Michigan Medicaid telehealth claims.

On documentation and consent, treat a telehealth session like a face-to-face one, plus telehealth-specific notes: document the modality used, the location of both client and provider, the names/roles of anyone else participating, session length, and that consent was obtained and recorded. Use a platform appropriate for protected health information and follow current privacy and security requirements — treat the specifics of platform and privacy compliance as items to confirm against current MDHHS, plan, and federal guidance, not something to eyeball.

Fee schedule files and the Code and Rate Reference

Coverage is code-specific. A service being "a therapy service" does not by itself mean the specific CPT/HCPCS code is telehealth-eligible for the modality you used. MDHHS maintains telemedicine fee schedule files (audio-visual and audio-only) and the Code and Rate Reference tool — that is where you confirm whether a code is telehealth-eligible at all, whether it is eligible audio-visual, audio-only, or both, and the current rate context.

Practical habit: before adding a telehealth code to your billing rules, look it up in the current fee schedule for the exact modality, and re-check at least annually and whenever a new code-update bulletin lands.

Fee-for-service vs. Medicaid Health Plan telemedicine claims

Michigan Medicaid is not a single billing lane, and telehealth claims follow the same routing logic as any other claim:

• MDHHS fee-for-service — you bill the state through CHAMPS, and MDHHS telemedicine policy (Manual + bulletins + fee schedules) governs.

• Medicaid Health Plan (MHP) — you bill the plan, which may layer its own telehealth rules (modifiers, POS, prior authorization, documentation) on top of the state floor.

• Specialty behavioral health (PIHP/CMHSP) — encounter/claim reporting follows that system's rules, which can differ (including the POS convention above).

Being enrolled in CHAMPS does not automatically mean you are in-network with every MHP or PIHP/CMHSP — that is separate credentialing and contracting. Confirm both the client's coverage (via eligibility verification) and your participation with the specific payer before you deliver and bill telehealth.

Common telehealth denials to design around

Most telehealth denials in Michigan Medicaid are avoidable coding/routing problems, not coverage problems:

• Wrong or missing modifier — no 95/93, or a modifier that does not match the actual modality.

• Wrong place of service — POS 02/10 where the in-person POS was expected (or vice versa for a plan that wants a telehealth POS).

• Code not telehealth-eligible for the modality billed (especially audio-only), or a deleted code such as the retired 99441–99443.

• Wrong payer route — billing MDHHS fee-for-service when the client is enrolled in an MHP or served through a PIHP/CMHSP.

• Thin documentation — no note of modality, locations, participants, or consent.

Telehealth billing checklist for therapists

Before the session, and again before the claim goes out:

• Verify eligibility and which payer covers the service today (FFS, MHP, or PIHP/CMHSP).

• Confirm the modality and whether the service is eligible that way.

• Look up the CPT/HCPCS code in the current telemedicine fee schedule for that modality.

• Attach the correct modifier (verify 95 vs. 93) and set the correct place of service for that payer/route.

• Obtain and document consent and the telehealth-specific note elements.

Action Steps for Providers

1. Pull the controlling documents first. Open the MDHHS Telemedicine page, MMP bulletin 23-10, the Telemedicine chapter of the Provider Manual, and the current telemedicine fee schedules — and confirm none has been superseded by a newer bulletin.

2. Verify your code list by modality. Check each psychotherapy code against the current audio-visual and audio-only fee schedule/Code and Rate Reference.

3. Lock in your modifier and POS logic per payer. Note that FFS uses the in-person POS + modality modifier (95/93), and where MHP/PIHP conventions differ — after confirming each in current policy.

4. Check the client's route every time. Run eligibility, confirm whether the claim goes to MDHHS FFS, an MHP, or a PIHP/CMHSP, and confirm you are contracted where required.

5. Standardize documentation. Build a note template capturing modality, both locations, participants, length, and consent.

6. Re-verify on a schedule — modifiers, POS, and code eligibility, at least annually and whenever a code-update bulletin is issued.

Where Bomi Fits

Telehealth billing rules quietly drain a therapy practice: they change, they differ by payer, and a small POS or modifier mismatch turns a legitimate session into a denied claim. Bomi helps therapy practices keep Michigan Medicaid billing and credentialing straight — eligibility checks to confirm the right payer route, clean claim submission, denial and EOB review, payer follow-up, credentialing workflows, and the day-to-day revenue operations that keep telehealth reimbursable.

Want help keeping Michigan Medicaid billing and credentialing workflows straight? Bomi helps therapy practices with eligibility checks, claims, denials, credentialing, payer follow-up, EOB review, and revenue operations so clinicians can spend more time with clients.

We do not replace your obligation to verify current policy, and we do not guarantee approval, contracting, or reimbursement — but we carry the operational load of getting telehealth claims coded, routed, and followed up correctly. Talk to Bomi about billing and credentialing.

This post is for general operational education and is not legal, compliance, or billing advice. Always confirm current MDHHS, Medicaid Health Plan, PIHP, CMHSP, and Provider Manual requirements before submitting enrollment, claims, or authorizations.

Sources

Primary Michigan Medicaid sources (these control — verify the current version before billing):

• MDHHS Telemedicine billing and reimbursement — telemedicine reference page; points to the Provider Manual, Code and Rate Reference, and fee schedules as controlling.

• MDHHS Medicaid Policy bulletin MMP 23-10 (Telemedicine) — telemedicine policy bulletin, including the Place of Service, modifier 95, and modifier 93 section.

• Michigan Medicaid Provider Manual — Telemedicine and Billing & Reimbursement chapters.

• CHAMPS Claims and Encounters — claim submission, adjustments, and status.

• Michigan Medicaid Health Plans — plan lists and service areas; check each plan for its own telehealth rules.

Current secondary references cross-checked for this post (not policy authority):

• Center for Connected Health Policy — Michigan telehealth policy — current-status summary of Michigan Medicaid telehealth policy (audio-only conditions, modifiers, POS, parity).

• Upper Midwest Telehealth Resource Center — Michigan Virtual Visit & Reimbursement Guide — payer-by-payer Michigan telehealth billing matrix, including Michigan Medicaid modality, POS, and modifier conventions.