MMP 26-46

The Michigan Department of Health and Human Services (MDHHS) issued bulletin MMP 26-46 on October 30, 2026, updating Medicaid coverage and billing requirements for routine maternity care services across the Medicaid, Healthy Michigan Plan, MI Coordinated Health, MOMS, and MIChild programs. The update is driven by the AMA CPT Editorial Panel's deletion, effective January 1, 2027, of global maternity care CPT codes (including 59400, 59510, 59620 for practitioners and 59425, 59426, 59430 for clinic settings) and the transition to per-encounter reporting using discrete E/M or other applicable CPT codes. Claims submitted with global maternity care CPT codes on or after January 1, 2027, are eligible for payment only if all dates of service occurred on or before December 31, 2026. Under the revised structure, providers must report antepartum and postpartum E/M services with modifier TH and appropriate obstetric ICD-10-CM diagnosis codes to qualify for the enhanced reimbursement rate described in bulletin MSA 14-32 and the Practitioner Reimbursement Appendix of the MDHHS Medicaid Provider Manual. A code from ICD-10-CM category Z3A may be appended to identify weeks of gestation. Documentation must support medical decision making or time consistent with current CPT guidelines. Labor management care may be reported once per calendar date and not on the same day as Hospital Care codes by the same provider; delivery care codes may be reported on the same day as labor management codes even when the same provider performs both. The bulletin caps enhanced reimbursement at 13 antepartum E/M visits per pregnancy and 2 postpartum E/M visits per pregnancy (the latter within 12 weeks postpartum). Visits beyond those thresholds are reimbursed at standard physician service payment rates. The bulletin expressly states that these thresholds are enhanced reimbursement thresholds, not Medicaid coverage limits, and that providers and Medicaid Health Plans must not deny, delay, or discourage medically necessary maternity care solely because an enhanced reimbursement threshold has been reached. FQHCs, RHCs, Tribal Health Centers, and Tribal FQHCs furnishing eligible antepartum and postpartum services in the clinic setting are reimbursed under Prospective Payment System or All-Inclusive-Rate methodology for qualifying visits, billed on an institutional claim form using a Type 2 clinic-specialty NPI with a Type 1 individual NPI in the Attending Provider field. Labor management and delivery care furnished by these entities in the hospital setting must be billed separately on a CMS 1500/837P professional claim form and is reimbursed under FFS methodology. Medicaid Health Plans and HIDE SNPs must provide at minimum the full range of covered services described in the bulletin and may develop prior authorization and documentation requirements that differ from FFS requirements in accordance with their contracts and applicable law.