Michigan Medicaid Fee Schedule 2026: Find Current CPT & HCPCS Rates

Author: Akash Biswas · Reviewer: Akash · Last reviewed: September 5, 2026

Michigan Medicaid does not use one fee schedule for every provider or service. Rates depend on the provider type, the billed code, and other claim details.

To find the correct rate, start with the Michigan Department of Health and Human Services (MDHHS) fee schedule for that provider category, then confirm code-level details in CHAMPS.

key facts at a glance

• Michigan Medicaid has no single, universal fee schedule — MDHHS publishes separate rate resources by provider and service category (physician, dental, DME, lab, behavioral health, facility, and more).
• To check a rate, match your provider category to the right MDHHS resource, then verify the exact code in CHAMPS’s Medicaid Code and Rate Reference.
• The rate that applies depends on the CPT/HCPCS code, provider type, date of service, modifier, prior authorization, and coverage rules — not the code alone.
• This guide covers fee-for-service billing. If a Medicaid Health Plan pays the claim, the plan’s contract and remittance advice — not the public MDHHS rate — determine payment.
• Two 2026 bulletins updated codes: MMP 26-03 (issued Jan. 22, 2026, effective Jan. 1, 2026) and MMP 26-15 (issued May 1, 2026, with retroactive dates for dental codes D9244/D9245 and CPT 77387). No MDHHS bulletin confirms a statewide percentage rate increase for 2026.
• Home Help rates, effective January 1, 2026: $17.13/hour for individual caregivers and $27.00/hour for agency providers (each already includes a $3.40 direct-care-worker pass-through).
• Dental general-anesthesia facility minimums (MMP 23-04, effective Oct. 1, 2022): $1,495 for ambulatory surgical centers, $2,300 for outpatient hospitals — separate from the dental procedure code’s own rate.
• Michigan Medicaid’s Clinical Laboratory Fee Schedule is its own state-published database (independent labs only) — it isn’t automatically tied to the federal CMS lab fee schedule.
• A fee-screen amount is reference information only — it doesn’t guarantee coverage or payment. The Provider Manual controls if it ever conflicts with a fee schedule.
• Looking for payment dates, not reimbursement rates? That’s a different resource — see the CHAMPS Payment Schedule.

Michigan Medicaid does not have one universal fee schedule

Michigan Medicaid does not have one universal fee schedule PDF for all providers and services. Instead, MDHHS provides separate provider-specific fee schedules and payment resources.

The correct Michigan Medicaid fee schedule depends on what you are billing:

• Physicians and practitioners: Professional fee schedule and CHAMPS
• DME, orthotics, and prosthetics: DME fee schedule
• Dental: Dental-specific fee schedule and billing resources
• Behavioral health: Behavioral health fee schedules and CHAMPS
• FQHCs, RHCs, and Tribal Health Centers: Facility-specific reimbursement lists
• Hospital outpatient and ASC: Outpatient and ASC payment resources
• Home health, hospice, ambulance, lab, and pharmacy: Provider-specific resources

Before using a Michigan Medicaid reimbursement rate, check the code, modifier, provider type, place of service, date of service, authorization, and coverage rules.

A fee schedule is a reference and does not guarantee payment. Always check the current MDHHS Medicaid Provider Manual and Provider Bulletins for final billing rules.

2026 Practitioner and Physician Rate Updates

Two MDHHS bulletins updated physician and practitioner billing codes for 2026. Neither one documents a statewide percentage rate increase.

MDHHS bulletin log

A code being added, deleted, or revised doesn’t mean its rate moved the same way it did last year. Check the procedure code, modifier, provider category, and effective date before billing off an older fee screen — MMP 26-15’s retroactive dates make this especially important for dental code D9244, D9245, and CPT 77387 claims.

Is there a statewide Michigan Medicaid rate increase for 2026?

No confirmed one. These bulletins update specific CPT and HCPCS codes. They don’t establish one across-the-board percentage increase for every Michigan Medicaid physician or practitioner.

A Medicare conversion-factor change isn’t proof of a Michigan Medicaid increase either — the two aren’t the same thing. Confirm any reimbursement change through the current professional fee schedule, CHAMPS, and the applicable bulletin, not a general percentage.

Before billing a code, verify:

• The exact CPT or HCPCS code
• The bulletin’s effective date, which can differ from its issue date
• Modifier, place of service, and provider type
• Whether the claim is fee-for-service or Medicaid Health Plan

Home Help Provider Payment Rates 2026

If you’re asking how much Medicaid pays family caregivers in Michigan through Home Help, here are the current state-set hourly rates. For services starting January 1, 2026, individual caregivers earn $17.13 per hour. Agency providers earn $27.00 per hour.

The $3.40 direct-care-worker pass-through is already built into both hourly rates above — don’t add it a second time.

For payment dates and the Home Help pay cycle, see the CHAMPS Payment Schedule.

Source: MDHHS Numbered Letter L-25-75 (Home Help rates), effective January 1, 2026. Verified September 5, 2026.

Dental, Behavioral Health, and Laboratory Fee Schedules

Dental, non-physician behavioral health, and clinical laboratory services each use their own MDHHS reimbursement resource. Don’t substitute the standard practitioner or physician fee schedule for any of these — the code set, payment method, and effective date can all differ by specialty. MDHHS

Non-physician behavioral health fee schedule

MDHHS publishes a dedicated Non-Physician Behavioral Health Fee Schedule, separate from the standard medical schedule. The currently indexed file is labeled January 2026. Before using a rate, confirm the service code, provider type, modifier, unit, and date of service — this file is reference material, not a coverage or payment guarantee. MDHHS

If you’re looking for a Medicaid ABA fee schedule, don’t assume every ABA service uses this same fee-for-service file. MDHHS also publishes separate SFY 2026 ABA rate material built for PIHP rate development, which follows a different delivery system and billing path. Confirm which one applies to your claim before using either.

Dental fee schedule and general-anesthesia facility rates

Michigan Medicaid’s dental reimbursement is separate from the medical professional fee schedule. The MDHHS January 2026 dental schedule lists dental codes, age ranges, rates, and effective dates, including anesthesia and sedation codes.

For covered dental services performed under general anesthesia in an ambulatory surgical center or outpatient hospital, MDHHS set separate minimum facility rates under MMP 23-04, effective October 1, 2022:

This facility rate is a separate payment component — it isn’t the dental procedure’s own fee-screen rate, and it isn’t necessarily the full amount paid on every claim. For a Medicaid dental fee schedule 2026 or dental reimbursement rate lookup, check the dental code, service setting, provider type, age range, and date of service before combining or assuming these amounts apply. MDHHS

Clinical laboratory fee schedule

Michigan Medicaid maintains its own Clinical Laboratory Fee Schedule, updated as separate July 2026, April 2026, and January 2026 files. This database applies to independent clinical laboratories only — lab services outside that scope fall under the Practitioner Fee Schedule instead. MDHHS

Don’t assume Michigan Medicaid automatically pays laboratory claims using the federal CMS Clinical Laboratory Fee Schedule. MDHHS maintains its own state-published schedule, and no current bulletin reviewed here confirms a blanket CMS-rate relationship.

Before using a laboratory rate, confirm:

• The lab is the provider type this database applies to
• The exact CPT or HCPCS code
• Modifier and age-range fields, if shown
• The correct rate file and actual date of service
• Whether the service instead belongs under the Practitioner Fee Schedule

DME suppliers should use the separate Michigan Medicaid DME fee schedule 2026 resource — not the dental, behavioral-health, or clinical laboratory files above.

How to look up a Michigan Medicaid CPT or HCPCS rate in CHAMPS

To check a Michigan Medicaid reimbursement rate for a specific code, use the matching MDHHS provider-specific fee schedule together with the Medicaid Code and Rate Reference in CHAMPS.

CHAMPS gives real-time, code-level information, but the final claim outcome still depends on coverage policy, authorization, documentation, and other billing rules — not the rate alone. MDHHS

1. Confirm the exact billable code. CPT for professional and medical services, HCPCS for supplies, DME, ambulance, and drugs, or CDT for dental. Make sure the code actually matches the service delivered and the provider category — a matching description isn’t enough.
2. Confirm the actual date of service. Michigan Medicaid schedules get revised through the year. Use the version that applied on the real date of service, not just the newest file available. A March 2026 claim needs the schedule and policy that applied in March 2026 — not a July 2026 update.
3. Identify the billing provider and service category. Physician/practitioner, DME/orthotics/prosthetics, dental, clinical laboratory, behavioral health, home health/hospice, ambulance, hospital outpatient/facility, or FQHC/RHC/Tribal Health Center each use a different resource. A practitioner rate won’t apply to the others.
4. Open the CHAMPS Medicaid Code and Rate Reference. Sign in under the billing NPI, then go to External Links → Medicaid Code and Rate Reference. MDHHS describes it as a real-time code-inquiry system covering rate information, required modifiers, age restrictions, prior authorization (and any medical-condition bypass), documentation requirements, frequency limits, diagnosis requirements, NDC data, DME per-diem rules, and dental tooth-number/surface requirements. MDHHS
5. Check whether a modifier changes payment. Confirm the modifier is valid for that code, provider type, place of service, and date of service. MDHHS notes that modifier and age-range fields on a professional fee schedule apply to the fee screen — seeing one doesn’t by itself mean the claim is covered.
6. Review remaining limits. Age restrictions, prior authorization, documentation, frequency, quantity, and diagnosis or medical-necessity requirements can all still apply even when a code shows a rate.
7. Confirm fee-for-service vs. Medicaid Health Plan status. This workflow is built for fee-for-service billing. For a Medicaid Health Plan claim, check the provider contract, the plan’s billing manual, the plan portal, and the remittance advice instead — the public MDHHS rate may not match the contracted payment.
8. Check the Provider Manual and current bulletins if the fee screen doesn’t answer the question. MDHHS updates the online Provider Manual quarterly to fold in bulletin policy. Use it when a code’s coverage is unclear, a code was recently added or revised, or a rate looks inconsistent with another MDHHS source. MDHHS
9. Still unresolved? Contact Provider Inquiry. For fee-for-service questions, MDHHS lists Provider Inquiry at 1-800-292-2550 or providersupport@michigan.gov. For a Medicaid Health Plan claim, use that plan’s provider-support channel and keep its response with your billing record.

Example: A clinic verifying a CPT code for a March 2026 date of service should confirm the code, provider category, modifier, place of service, unit calculation, and the March 2026 schedule and policy version — not whatever file happens to be newest when they check.

What to verify before using a Michigan Medicaid fee-screen amount

A Michigan Medicaid fee-screen amount is reference information, not a guarantee that a specific claim is covered, payable, or payable at that amount.

MDHHS points providers to the Provider Manual and current MMP Bulletins for coverage and reimbursement policy — if a fee schedule ever conflicts with the Provider Manual on rate or coverage, the manual controls. MDHHS

Does a Michigan Medicaid fee schedule guarantee payment? No. A claim can still be denied, adjusted, or paid differently if the code, modifier, provider type, date of service, authorization, documentation, coverage policy, quantity, frequency, setting, enrollment, or managed-care contract doesn’t line up with requirements.

Why was a claim denied when the code has a rate? Common reasons include: wrong provider/service category, a missing or incorrect modifier, a date-of-service mismatch, missing prior authorization, a documentation or medical-necessity issue, a frequency or quantity limit, wrong place of service, a coverage exclusion, a provider enrollment/NPI issue, or a Medicaid Health Plan contract rule.

Check the current Provider Manual, the applicable bulletin, CHAMPS, and the remittance advice to identify the cause before rebilling or appealing. MDHHS

Michigan Medicaid fee-for-service rates vs. Medicaid Health Plan payments

A Michigan Medicaid fee-for-service rate and a Medicaid Health Plan payment aren’t always the same thing. The MDHHS fee schedule and CHAMPS are your reference for fee-for-service billing. A Medicaid Health Plan claim is governed by the provider’s contract, the plan’s billing rules, and the remittance advice instead. MDHHS

Are managed-care rates the same as fee-schedule rates? Not necessarily. A public MDHHS fee screen is relevant for fee-for-service billing, but it isn’t automatically the final payment for a plan-administered claim. In some specific, program-defined circumstances MDHHS requires certain plans to pay noncontracted providers at the FFS rate — but that’s a narrow rule, not a general one. MDHHS

Why might my plan’s payment differ from the state schedule? Usually one of these:

• The provider’s negotiated contract rate
• The plan’s own pricing rules or methodology
• Network vs. non-network provider status
• A claim edit, bundling rule, or coordination-of-benefits issue
• The code, modifier, units, or place of service billed

A lower payment doesn’t automatically mean MDHHS’s schedule was ignored. First confirm whether the claim was paid fee-for-service or by a Medicaid Health Plan, then check the remittance advice against that source.

Does this apply to my specific health plan? It depends on your plan’s contract and billing rules, not a general answer. This guide doesn’t state plan-specific payment terms (for example, for Molina or Meridian) unless a current, directly sourced plan document confirms them. Review your provider agreement, the plan’s billing manual, and the remittance advice, then contact the plan’s provider-support line if payment is still unclear.

Michigan Medicaid fee schedule PDF, XLSX, and historical rates

There’s no single downloadable file that covers every Michigan Medicaid provider and year. The right format — PDF, XLSX, a reimbursement list, or a CHAMPS lookup — depends on the provider category. MDHHS

Where do I download the fee schedule? Start at MDHHS’s Billing and Reimbursement → Provider Specific Information page, then choose the category that matches your claim. Don’t assume a file is correct just because it’s titled “fee schedule” — confirm it matches your provider category, service, and date of service.

Does MDHHS publish XLSX fee schedules? Yes. Many provider-specific schedules are XLSX files listing code, modifier, age range, rate, and effective date. Treat these as versioned billing references, not permanent rate lists — always check the file’s publication or revision date and the effective-date field. MDHHS

How do I find a past fee schedule? Check the matching MDHHS provider page for an archive or historical file first. MDHHS keeps some historical materials and provider alert archives, but availability isn’t the same across every provider type or year. MDHHS If the period you need isn’t posted, contact MDHHS directly rather than estimating it from a newer schedule.

Can I use a 2026 fee schedule for a 2025 date of service? No. Use a schedule that matches the actual date of service. A current 2026 schedule should not be assumed to establish payment for a 2025 service date — codes, rates, and modifiers can all change between periods. Never calculate an older rate by applying a percentage to today’s rate.

Frequently asked questions

Sources and official resources

This is an independently published guide, not an MDHHS website. Michigan Medicaid rates, code status, prior authorization, and coverage rules can change. Always verify against the source that matches your provider type and the claim’s date of service before billing.

Official Michigan Medicaid fee schedules

• MDHHS Provider-Specific Billing and Reimbursement Information — MDHHS’s directory for finding the right provider-category resource (professional, dental, DME, laboratory, behavioral health, facility, pharmacy, ambulance, home health, and more).
• MDHHS Physicians, Practitioners, and Medical Clinics Fee Schedules — Professional fee-screen information: procedure codes, descriptions, and rates.
• MDHHS Dental Fee Schedule — Current dental fee schedule (January 2026 XLSX) and links to CHAMPS for billing indicators.
• MDHHS DME, Orthotics, Prosthetics, and Medical Suppliers Fee Schedule — DME, orthotics, prosthetics, and supply reimbursement information.
• MDHHS Clinical Laboratory Fee Databases — 2026 clinical laboratory fee databases (July, April, January), valid for independent clinical laboratories only.
• MDHHS Outpatient Hospital Billing and Reimbursement Information — Hospital outpatient rates and facility-specific billing rules.

Code, policy, and billing verification

• CHAMPS Medicaid Code and Rate Reference Tool — Sign in to CHAMPS under your billing NPI, then go to External Links → Medicaid Code and Rate Reference for real-time rate, modifier, authorization, and documentation details.
• MDHHS Medicaid Provider Manual — Coverage, billing, and reimbursement policy. Controls when a fee schedule and the manual disagree.
• MDHHS Policy, Letters, and Forms — Central location for the Provider Manual, bulletins, and forms.
• 2026 Michigan Medicaid Policy Bulletins — Current MMP Bulletin log for code updates and policy changes.
• MMP 26-03: CPT and HCPCS Code Updates — Issued January 22, 2026; effective for dates of service on or after January 1, 2026.
• MMP 26-15: CPT and HCPCS Code Updates — Issued May 1, 2026; April code updates, including retroactive dates for specific codes.

Home Help and payment timing

• MDHHS Home Help Payment Schedule 2026 — Service-verification and warrant-delivery dates. This is a payment calendar, not a CPT/HCPCS fee schedule.
• MDHHS Home Help Individual Caregiver Rate Notice (L-25-75) — Effective January 1, 2026: $17.13/hour individual caregiver rate ($13.73 base + $3.40 pass-through).
• MDHHS Adult Services Manual: County Rates — Home Help rate components for individual caregivers and agency providers.

Provider support

For unresolved Michigan Medicaid fee-for-service billing questions:

• Provider Inquiry: 1-800-292-2550 · ProviderSupport@michigan.gov
• Atypical-provider questions: 1-800-979-4662

Contact details can change — confirm current numbers on the official MDHHS provider pages before relying on them. MDHHS

Before you bill

Match the official MDHHS resource to: your provider or service category, the exact billing code, the claim’s date of service, the modifier/units/place of service/authorization status, and whether the claim is fee-for-service or managed care. A fee-screen amount is reference information — not a guarantee of coverage or payment. When in doubt, the Provider Manual and current bulletins control. MDHHS

Last reviewed: September 5, 2026