Michigan Billing Guide for Mental Health Therapists and Psychiatrists
Who pays, where to enroll and which rules change your claims in Michigan, for psychotherapists and psychiatric prescribers.
Last checked October 25, 2026. Reviewed against the official sources listed at the bottom of this page.
This Michigan billing guide covers Medicaid, Medicare, Blue Cross, other private payers and state law for therapists and psychiatrists, with sources and a last-checked date.
Michigan billing guide: how Michigan pays for outpatient care
Michigan Medicaid is run by the Department of Health and Human Services (MDHHS) and splits behavioral health in two. Medicaid Health Plans cover outpatient therapy for mild to moderate needs. Regional Prepaid Inpatient Health Plans (PIHPs) and community mental health agencies serve people with serious needs.
Michigan Medicaid fee-for-service still applies to some members. A July 2026 MDHHS bulletin changes how master's-level limited-licensed providers enroll and bill, effective September 1, 2026.
Who to bill, at a glance
| Payer type | Who you bill | Where to enroll or check rules |
|---|---|---|
| Medicaid | MDHHS; nine Medicaid Health Plans; regional PIHPs for specialty care | MDHHS |
| Medicare Part B | WPS Government Health Administrators, Jurisdiction 8 | CMS MAC page |
| Blue Cross Blue Shield | Blue Cross Blue Shield of Michigan and Blue Care Network | See the Blue Cross section below |
Michigan Medicaid: Michigan Medicaid and Healthy Michigan Plan
This Michigan billing guide starts with Medicaid, because it decides who pays and how you file.
Medicaid Health Plans cover physical health and outpatient behavioral health for mild to moderate needs. Specialty behavioral health for adults with serious mental illness, children with serious emotional disturbance, substance use and developmental disabilities is administered by regional PIHPs with local community mental health service programs. Priority Health's Medicaid manual says to bill the PIHP in the member's county of residence for PIHP-served members.
Fee-for-service providers enroll and bill through CHAMPS, the Community Health Automated Medicaid Processing System.
| Item | What to know |
|---|---|
| Agency | Michigan Department of Health and Human Services |
| Medicaid Health Plan list | MDHHS Medicaid Health Plan service area listing, dated 1/10/2025 |
| Limited-licensed providers | MDHHS bulletin MMP 26-30-BH, issued 7/31/2026 and effective 9/1/2026: master's-level limited-licensed providers enroll in CHAMPS as Rendering Only with the supervisor's NPI, payment goes to the associated billing provider, and services are no longer billed under the supervisor's NPI. Existing providers must add supervisor information by 11/1/2026. Source |
| Fee-for-service filing window | Claims must be received within 12 months of the date of service. MSA 16-37 |
| Work requirement | MDHHS says Healthy Michigan Plan work requirements start in January 2027 for certain members 19 to 64, and most members move to six-month renewals. MDHHS release, 7/23/2026 |
Managed-care plans and carve-outs
| Plan or entity | Role in behavioral health |
|---|---|
| Aetna Better Health of Michigan | On the MDHHS Medicaid Health Plan list. |
| Blue Cross Complete of Michigan | On the MDHHS list. |
| HAP CareSource | On the MDHHS list. |
| McLaren Health Plan | On the MDHHS list. |
| Meridian Health Plan of Michigan | On the MDHHS list. |
| Molina Healthcare of Michigan | On the MDHHS list. |
| Priority Health Choice | Covers outpatient therapy for mild to moderate needs and refers severe cases to the PIHP. |
| UnitedHealthcare Community Plan | On the MDHHS list. |
| Upper Peninsula Health Plan | On the MDHHS list. |
Confirm the current plan roster on the MDHHS site before you contract.
Medicare Part B in Michigan
For Medicare, this Michigan billing guide names your contractor and the current telehealth rules.
Medicare Part B pays for outpatient psychotherapy and psychiatric visits billed to the Medicare Administrative Contractor (MAC) for your state. CMS's July 14, 2026 fact sheet on the CY2027 Physician Fee Schedule proposed rule says the Consolidated Appropriations Act, 2026 extended telehealth payment authority through December 31, 2027, and proposes that in-person visit requirements for mental health visits not apply to services furnished through that date.
| Item | What to know |
|---|---|
| Contractor | WPS Government Health Administrators |
| Jurisdiction | Jurisdiction 8: Indiana and Michigan |
| Source | CMS.gov MAC page |
Blue Cross Blue Shield in Michigan
This part of the Michigan billing guide names the exact Blue Cross licensee, because Blue plans never share rules.
Blue Cross Blue Shield is a federation of independent companies, so one licensee's rules never apply to another. In Michigan that is Blue Cross Blue Shield of Michigan (BCBSM), a nonprofit mutual corporation and independent licensee of the Blue Cross Blue Shield Association, and its HMO, Blue Care Network (BCN). BCN says it has access in all 83 Michigan counties. Their rules do not apply to Blue plans in other states.
| Licensee | Parent or affiliation | Where it applies | Provider resources |
|---|---|---|---|
| Blue Cross Blue Shield of Michigan | Nonprofit mutual corporation; independent licensee | Michigan | BCBSM provider information |
| Blue Care Network | Owned by Blue Cross Blue Shield of Michigan | All 83 Michigan counties, per BCN | BCN fast facts |
Other private payers and EAPs in Michigan
The Michigan billing guide also covers commercial plans and employee assistance programs.
These commercial payers and plan families most often matter for behavioral health billing in Michigan. Check each payer's current provider manual before you submit.
| Payer | Behavioral health note | Provider resources |
|---|---|---|
| BCBSM paper claims | A June 30, 2026 BCBSM alert gives new consolidated paper-claim addresses. Old PO boxes stop receiving paper claims October 1, 2026. Electronic 837 claims are preferred. | Official page |
| Priority Health | Priority Health's manual lists in-network commercial behavioral health provider types, and says limited-license practitioners cannot be credentialed and bill under a supervisor's NPI with modifier AJ (LLMSW) or HO (LLC and TLLP). Paid on CMS-1500. | Official page |
| Cigna / Evernorth Behavioral Health | The Evernorth administrative guide prefers electronic claims and says EAP claims must use CPT 99404. | Official page |
Michigan billing guide: state law that changes billing
Use this section of the Michigan billing guide to separate state law from payer policy.
State law sets the floor for commercial plans in Michigan. Medicare and Medicaid rules are covered in their own sections above.
Prompt payment and timely filing
Michigan's Department of Insurance and Financial Services says a clean claim must be paid within 45 days of receipt, with notice of known defects within 30 days and 12% simple interest on late clean claims. Providers must bill within one year of the date of service. It excludes Medicare, Medicare Advantage, self-funded plans and Medicaid. DIFS
Practitioner scope: therapists
Priority Health's manual shows the Michigan professional types used in billing: licensed psychologists, limited licensed psychologists, LMSWs, LPCs, LMFTs and behavior analysts. Limited-license trainees bill under a supervisor. Source
Not legal advice. Confirm statute details with counsel.
Michigan billing guide: codes and rates
This Michigan billing guide lists only codes and rates confirmed on official pages.
These are the Michigan-specific codes, modifiers and rate items confirmed on official pages. Medicare's own CY2027 conversion factor proposal is listed under What changed.
| Code or item | What to know |
|---|---|
| H0002 (MichiCANS Screener) and H0031 (LOCUS) | From 9/1/2026, Medicaid fee-for-service reports these HCPCS codes for those purposes regardless of the national descriptors. They may be furnished by audio-visual or audio-only telemedicine. Source |
| Priority Health supervisor modifiers | AJ for LLMSW and HO for LLC and TLLP. Report the supervisor's Type 1 NPI in field 24J. Source |
Michigan billing guide: what changed, newest first
Check this Michigan billing guide update log before you rely on an older rule.
| Date | What changed | Source |
|---|---|---|
| 2027-01-01 | Healthy Michigan Plan work requirements and six-month renewals start in January 2027. | Source |
| 2026-10-01 | BCBSM and BCN consolidated paper-claim addresses take effect. Old PO boxes stop receiving paper claims. | Source |
| 2026-09-01 | MMP 26-30-BH takes effect for limited-licensed providers in Medicaid fee-for-service. | Source |
| 2026-07-31 | MDHHS issued MMP 26-30-BH. | Source |
| 2026-07-23 | MDHHS announced Healthy Michigan Plan work requirements. | Source |
| 2026-07-14 | CMS released the CY2027 Medicare Physician Fee Schedule proposed rule: conversion factor $32.84 for non-qualifying APM participants (down 1.68%) and $33.17 for qualifying participants (down 1.19%). | Source |
How do I bill mental health claims in Michigan?
These answers come from the same sources as the rest of this Michigan billing guide.
Start with the member's need level. For Michigan Medicaid, bill the member's Medicaid Health Plan for mild to moderate outpatient therapy, and the PIHP in the member's county for specialty services. Medicare Part B goes to WPS in Jurisdiction 8. Blue Cross Blue Shield of Michigan and its HMO, Blue Care Network, are the Blue plans.
Questions about billing in Michigan
Who do I bill for Michigan Medicaid behavioral health claims?
Bill the Medicaid Health Plan for mild to moderate outpatient therapy and the PIHP in the member's county for specialty services. Fee-for-service uses CHAMPS.
What changed for limited-licensed providers in Michigan Medicaid?
Under MMP 26-30-BH, effective September 1, 2026, they enroll as Rendering Only with the supervisor's NPI and payment goes to the associated billing provider.
What is the Michigan commercial prompt-pay rule?
A clean claim must be paid within 45 days, with 12% simple interest on late payment, according to DIFS.
Is Blue Care Network the same as BCBSM?
Blue Care Network is the HMO owned by Blue Cross Blue Shield of Michigan. Check the member's card for the plan.
Does MCM South bill for practices in Michigan?
MCM South currently serves ten states; request a quote to ask about Michigan.
Sources for the Michigan billing guide
Last checked October 25, 2026. Every source below was opened and read on that date.
- MDHHS, checked October 25, 2026
- MDHHS Medicaid Health Plan listing, checked October 25, 2026
- MDHHS bulletin MMP 26-30-BH, checked October 25, 2026
- MDHHS bulletin MSA 16-37, checked October 25, 2026
- MDHHS work requirements release, checked October 25, 2026
- CMS: MAC Jurisdiction 8, checked October 25, 2026
- BCBSM provider information, checked October 25, 2026
- BCN fast facts, checked October 25, 2026
- Priority Health Medicaid behavioral health, checked October 25, 2026
- Priority Health behavioral health billing, checked October 25, 2026
- Michigan DIFS clean claim page, checked October 25, 2026
- Evernorth administrative guide, checked October 25, 2026
- CMS: CY2027 Physician Fee Schedule proposed rule fact sheet, checked October 25, 2026
- CMS MAC jurisdiction page, checked October 25, 2026
Related guides
- State & Regional Billing Guides hub
- In-network vs out-of-network credentialing
- Credentialing and network status
- Blue Cross Blue Shield guide for Michigan
- Mental health parity explained
- Medicaid managed care billing
- Medicare behavioral health billing
- Timely filing in the billing glossary
- Who we serve
- Illinois insurance companies contact guide
Billing in Michigan? Let us handle the payer calls.
MCM South bills only mental and behavioral health, for psychotherapists and psychiatrists, in solo and medium-size practices. We currently serve ten states; request a quote to ask about Michigan.
MCM South currently serves practices in ten states: Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois.