Michigan Medicaid physical therapy coverage: telehealth, limits and prior authorization
The short answerMichigan fee-for-service Medicaid covers 144 units of PT per calendar year, with prior authorization beyond that (MDHHS 2024 outpatient therapy guide). Maintenance PT is 4 visits per 90 days. Evaluations must be in person even though some therapy can be telemedicine.
By Javier Alvarez · Updated · 1 min read
1 row: Medicaid (by state) · Michigan. Public policy, not the member's benefits.
Michigan Medicaid
MDHHS Medicaid outpatient therapy guide (2024 coverage and FFS prior authorization) · Michigan
| Telehealth modifier | Therapy PA requests and claims must carry GP for physical therapy. Habilitative therapy adds modifier 96, and maintenance therapy adds modifier TS. [1] |
|---|---|
| Telehealth rules | Some therapy services may be provided via telemedicine (check the state telemedicine database for covered services). Evaluations must be performed in person. Group therapy is not covered. [1] |
| Visit limits | Fee-for-service Medicaid covers up to 144 units of PT per calendar year for rehabilitative therapy (and the same for habilitative therapy when the beneficiary is eligible). Maintenance therapy is covered up to 4 visits per 90 days, with those 4 visits not exceeding 16 units. More requires prior authorization. [1] |
| Prior authorization | PA is needed when rehabilitative or habilitative PT exceeds 144 units a year, or maintenance exceeds 4 times or 16 units per 90 days. Continued therapy can be requested up to 6 months at a time, at least three weeks before the limit. PA is not granted retroactively; submit form MSA-115 with the evaluation, prior-period summary, goals, and prescription. [1] |
| Referral | All services must be ordered by the beneficiary's primary care or specialty medical provider. [1] |
| Managed care plans | The benefit and PA rules apply to fee-for-service. Medicaid Health Plans and Integrated Care Organizations must cover the services but may set different PA requirements, so check with the member's plan. [1] |
What Michigan Medicaid's documents say
The table above has every field we found for Michigan Medicaid, with numbered sources. In short:
- Prior authorization. PA is needed when rehabilitative or habilitative PT exceeds 144 units a year, or maintenance exceeds 4 times or 16 units per 90 days. Continued therapy can be requested up to 6 months at a time, at least three weeks before the limit. PA is not granted retroactively; submit form MSA-115 with the evaluation, prior-period summary, goals, and prescription.
- Visit limits. Fee-for-service Medicaid covers up to 144 units of PT per calendar year for rehabilitative therapy (and the same for habilitative therapy when the beneficiary is eligible). Maintenance therapy is covered up to 4 visits per 90 days, with those 4 visits not exceeding 16 units. More requires prior authorization.
- Telehealth rules. Some therapy services may be provided via telemedicine (check the state telemedicine database for covered services). Evaluations must be performed in person. Group therapy is not covered.
Other physical therapy rows for Michigan
Blue Cross Blue Shield of Michigan and BCN.
Check Michigan Medicaid's claim against the row
Before the claim goes out, compare it with the row above: the evaluation code matches the complexity you documented, the timed codes fit the minutes, any prior authorization covers the visit, and the plan of care is signed when the payer asks for it. The physical therapy table compares Medicaid with every other payer we checked.