Health Care Service Rules

Health Care Service Rules

The 2023 Health Care Services Rules and Fee Schedule are effective October 12, 2023.

LEO – 2023 Rules Manual and Fees (michigan.gov)

Source documentation has been updated to use 2023 CPT codes, 2023 HCPCS codes and the 2023 Michigan RBRVS Fee schedule utilizes 2023 October release CMS Fee Schedule data.

DME (Durable Medical Equipment) rental rule: If rental DME or supplies are not listed in the fee schedule, have no MAP, or are billed with a not otherwise specified code, then reimbursement must be one of the following: a) The daily rental rate must be calculated using the provider’s acquisition cost, plus 20%, divided by 365. b) If the provider is the manufacturer of the DME, the daily rental rate must be calculated using the manufacturer’s cost to produce the DME, plus 20% divided by 365. A provider’s failure to provide the required acquisition cost or manufacturer’s cost may result in denial of reimbursement. All items and services associated with the DME rental must be included in the daily rental rate, unless otherwise indicated in the 2023 HCPCS codebook.

Modifier CO- (15) Modifier -CO must be appended to a procedure code if the procedure was furnished entirely by the occupational therapy assistant, or if the occupational therapy assistant (OTA) has provided a portion of a procedure, separately from the part that is furnished by the occupational therapist, exceeding 10% of the total time for the procedure code. When modifier -CO is used, the procedure code must be reimbursed at 85% of the maximum allowable payment, or the usual and customary charge, whichever is less. Modifier -CO and the corresponding 15% reduction must not be applicable if the  occupational therapist has provided more than half of the timed procedure code without the minutes provided by the OTA.

Modifier CQ- CQ must be appended to a procedure if the procedure was furnished entirely by the physical therapy assistant, or if the physical therapy assistant (PTA) has provided a portion of a procedure, separately from the part that is furnished by the physical therapist, exceeding 10% of the total time for the procedure code. When modifier -CQ is used, the procedure code must be reimbursed at 85% of the maximum allowable payment, or the usual and customary charge, whichever is less. Modifier -CQ and the corresponding 15% reduction must not be applicable if the physical therapist has provided more than half of the timed procedure code without the minutes provided by the PTA.