Behavioral Health Billing Services in Michigan
Last reviewed October 6, 2026 by the Healthcare Logic revenue cycle team.
Michigan splits Medicaid behavioral health into two channels. Medicaid Health Plans cover mild to moderate needs, and regional Prepaid Inpatient Health Plans (PIHPs) working with Community Mental Health Services Programs (CMHSPs) cover specialty services. Billing the wrong channel is the most common Michigan denial.
Healthcare Logic supports Michigan therapists, group practices, CMHSP-contracted providers, SUD programs and FQHCs with billing, authorizations, coding, CHAMPS enrollment, denials and credentialing.
Michigan behavioral health billing at a glance
| Medicaid programs | Michigan Medicaid and the Healthy Michigan Plan |
|---|---|
| Mild to moderate behavioral health | Medicaid Health Plans (MHPs) |
| Specialty behavioral health | 10 regional PIHPs with CMHSPs: SMI, SED, SUD and I/DD services for about 300,000 people |
| 2026 status | MDHHS withdrew its PIHP rebid in February 2026; the existing PIHP structure remains |
| Provider enrollment | CHAMPS |
| Medicare contractor | Wisconsin Physicians Service, Jurisdiction 8 |
How Michigan Medicaid pays for behavioral health
Michigan Medicaid and Healthy Michigan Plan members get outpatient behavioral health for mild to moderate conditions through their Medicaid Health Plan. Specialty services for adults with serious mental illness, children with serious emotional disturbance, people with substance use disorders and people with intellectual and developmental disabilities are managed by PIHPs, which contract with CMHSPs and community providers.
In August 2025 MDHHS released an RFP to rebid PIHP contracts and cut the number of regions from 10 to 3. On January 8, 2026 a court found the RFP conflicted with the Michigan Mental Health Code, and MDHHS withdrew it in February 2026. The existing 10-region PIHP system stays in place for now, but providers should watch for a revised approach.
- Providers in the specialty system must complete PIHP or CMHSP enrollment separately from Medicaid Health Plan credentialing.
- MDHHS policy bulletins (for example MMP 26-17, effective July 1, 2026, on where specialty services can be delivered) change billing rules during the year.
- Medicaid enrollment and fee-for-service billing run through CHAMPS.
- Authorization and rates for specialty services are set by the PIHP and CMHSP contracts.
Medicare rules for Michigan behavioral health providers
Medicare rules are federal, so they are the same in Michigan as everywhere else. What changes is the contractor: Michigan clinicians enroll and bill Part B through Wisconsin Physicians Service (Jurisdiction 8).
- Counselors and MFTs can bill Medicare. Since January 1, 2024, marriage and family therapists and mental health counselors (including LPCs) can enroll in Medicare and bill for their services, paid at 75% of the physician fee schedule amount.
- Home telehealth is permanent for mental health. Patients can receive mental and behavioral health telehealth at home, anywhere in the country, and audio-only is allowed when the patient cannot or does not want to use video.
- The in-person visit rule is delayed. The requirement for an in-person visit within six months before starting tele-mental health, and every 12 months after, is waived until January 1, 2028 under the Consolidated Appropriations Act of 2026. Broader Medicare telehealth flexibilities run through December 31, 2027.
- Incident-to under general supervision. Behavioral health services by auxiliary personnel can be billed incident-to a supervising practitioner under general supervision.
- Tele-prescribing of controlled substances. DEA and HHS extended telemedicine prescribing flexibilities through December 31, 2026.
- Medicare Advantage is different. MA plans set their own networks and prior authorization rules, so we verify each MA plan before the first visit.
Michigan commercial plan notes
Michigan commercial plans often route behavioral health through a separate vendor with its own payer ID. We confirm vendor, network and telehealth rules for each plan before the first claim.
Common behavioral health denials in Michigan
These are the patterns we see most often with Michigan behavioral health claims, and each one is preventable with front-end checks:
- Specialty services billed to the Medicaid Health Plan, or mild to moderate services billed to the PIHP.
- Provider not enrolled with the PIHP or CMHSP for the member's region.
- Missing CMHSP authorization for specialty services.
- CHAMPS enrollment data not matching the claim.
- Services billed under policy that changed in a recent MDHHS bulletin.
Core behavioral health codes we bill in Michigan
Psychotherapy codes are time based, so documented start and stop times or total minutes must support the code billed. State Medicaid programs and plans may also require HCPCS codes, modifiers or rate codes on top of these.
| 90791 / 90792 | Psychiatric diagnostic evaluation (without / with medical services) |
|---|---|
| 90832 / 90834 / 90837 | Individual psychotherapy, 16 to 37, 38 to 52, and 53+ minutes |
| 90833 / 90836 / 90838 | Psychotherapy add-ons with an E/M visit |
| 90785 | Interactive complexity add-on |
| 90839 / 90840 | Psychotherapy for crisis, first 60 minutes / each extra 30 |
| 90846 / 90847 / 90853 | Family psychotherapy without / with patient; group psychotherapy |
| 96127 | Brief emotional or behavioral assessment (for example PHQ-9, GAD-7) |
Behavioral health billing services for Michigan providers
Healthcare Logic works inside your EHR and clearinghouse as an extension of your team. Use one service or the full revenue cycle:
Learn more about our behavioral health revenue cycle services, how we handle behavioral health coding, and credentialing for new clinicians.
Frequently asked questions
Who pays for behavioral health for Michigan Medicaid members?
Medicaid Health Plans pay for mild to moderate behavioral health. Specialty services for SMI, SED, SUD and I/DD are managed by regional PIHPs working with CMHSPs.
What happened to Michigan's PIHP procurement?
MDHHS issued an RFP in August 2025 to reduce PIHP regions from 10 to 3. After a January 8, 2026 court ruling found conflicts with the Mental Health Code, MDHHS withdrew the RFP in February 2026, so the existing PIHPs remain.
Do I need separate PIHP enrollment in Michigan?
Yes. Specialty system providers enroll with the PIHP or CMHSP in addition to Medicaid Health Plan credentialing and CHAMPS enrollment.
Can LPCs and LMFTs in Michigan bill Medicare?
Yes. Since January 1, 2024, licensed professional counselors and marriage and family therapists can enroll in Medicare. In Michigan they enroll through WPS, Jurisdiction 8.
How does Healthcare Logic help Michigan behavioral health providers?
We route each service to the right channel, manage PIHP, CMHSP and plan enrollment, secure authorizations, code and bill to contract rules and work denials and appeals.
Talk to a behavioral health billing specialist
Tell us your payer mix and EHR, and we will show you where Michigan claims are getting stuck. Business inquiries only. Reply within 1 business day.
Behavioral health billing in other states
Sources
Payer rules change often. This page reflects official guidance as of October 6, 2026. Confirm current requirements in the state manual and your payer contracts before billing.