Michigan Medicaid Fee Schedule 2026

Last Updated: February 20, 2026 | Source: Michigan MDHHS, CMS 2026 Physician Fee Schedule

The Michigan Medicaid Fee Schedule 2026 sets the maximum rates the state pays providers for Medicaid services.

Effective January 1, 2026, MDHHS updated its rates to align with the federal CMS 2026 Physician Fee Schedule, including a 2.5% statutory payment increase.

These changes affect physicians, behavioral health providers, dentists, home help workers, labs, and ambulance services across Michigan.

Quick Summary — What You’ll Learn:

• ✅ Michigan Medicaid rates increased by 2.5% starting January 1, 2026
• ✅ Auto No-Fault medical fee caps jumped 13.12% for 2026
• ✅ Home Help provider rates rose to $15.92/hour
• ✅ Telehealth billing restrictions for inpatient/nursing facility visits are now permanently removed
• ✅ New HCPCS codes adopted via Bulletin MMP 26-03 (issued January 22, 2026)
• ✅ Workers’ Comp now limits physician-dispensed drug reimbursement to 42 days

What Is the Michigan Medicaid Fee Schedule?

The Michigan Medicaid Fee Schedule is the official list of maximum reimbursement rates paid by the Michigan Department of Health and Human Services (MDHHS) to providers.

It covers procedure codes, billing indicators, and fee screens for services under Medicaid, the Healthy Michigan Plan, Children’s Special Health Care Services (CSHCS), MIChild, Maternity Outpatient Medical Services (MOMS), and other MDHHS-administered programs.

These rates represent the maximum the state will pay. Actual payments may be lower depending on the covered service, the beneficiary category, and the type of provider billing.

Who Manages the Fee Schedule?

MDHHS administers the fee schedule through the Community Health Automated Medicaid Processing System (CHAMPS) — the state’s official claims processing system.

Providers can look up real-time 2026 procedure-code rates using the Medicaid Code and Rate Reference tool inside CHAMPS.

Fee schedules are updated annually, with a three-year history maintained on the site. Older schedules are available via a FOIA request.

To determine whether your patients qualify for these services, review the 2026 Michigan Medicaid eligibility guidelines, which outline income thresholds and coverage groups.

Michigan Medicaid 2026 Key Rate Updates at a Glance

Michigan’s 2026 fee schedule includes significant updates across multiple provider types. Here is a summary of the most important changes:

Practitioner and Physician Fee Schedule 2026

Michigan Medicaid practitioner rates are now benchmarked to the updated federal CMS 2026 Physician Fee Schedule.

The 2026 update implements a one-time 2.5% statutory increase included in H.R. 1, creating two separate conversion factors based on provider participation type.

2026 Conversion Factors

These conversion factors are the base multipliers used to calculate reimbursement for specific CPT/HCPCS procedure codes.

New HCPCS codes were formally adopted under Bulletin MMP 26-03, issued January 22, 2026, covering dates of service on or after January 1, 2026.

Top CPT Codes Reviewed for 2026 Access

The MDHHS published a Medicaid Reimbursement Rates Report (September 30, 2025) under Public Act 121 of 2024, analyzing the top 50 CPT codes where current Michigan rates may limit patient access.

Michigan was compared to Midwestern peer states — Illinois, Indiana, and Minnesota.

Key CPT codes reviewed include:

Important Note: Exact dollar amounts for these codes are maintained in real-time through the CHAMPS Medicaid Code and Rate Reference tool. Always look up rates directly on the MDHHS provider portal for the most current data.

For a broader national comparison, the Medicaid Fee Schedule 2026 resource provides side-by-side data across all states.

Telehealth Policy Changes in 2026

Telehealth access expanded significantly for Michigan Medicaid in 2026. Frequency restrictions on inpatient and nursing facility visits have been permanently removed, giving providers greater billing flexibility for virtual care.

Additional Federal Telehealth Updates

• FQHCs and RHCs can now bill for telehealth services through December 31, 2026.
• Direct supervision now permanently includes virtual presence via audio/video real-time communications technology.
• Teaching physicians may have a virtual presence for resident services performed virtually.
• Marriage and family therapists and mental health counselors can bill Medicare directly for community health integration and principal illness navigation services.

Behavioral Health and Dental Fee Schedules

Michigan’s behavioral health reimbursement model was updated to better support mental health providers.

These changes do not affect physicians (MD, DO, NP, PA) — only non-physician behavioral health and substance abuse providers.

Behavioral Health

Effective October 1, 2025 (carrying into 2026), payments for non-physician behavioral health services are now based on the dedicated Non-Physician Behavioral Health Fee Schedule, decoupling them from the standard medical clinic schedule.

Michigan currently ranks 7th lowest nationally for Medicaid reimbursement rates for psychiatrists and behavioral health providers — a key access barrier MDHHS is working to address.

New add-on codes for advanced primary care management services now complement established Behavioral Health Integration (BHI) and Collaborative Care Model (CoCM) services.

Dental

As of January 1, 2026, the dental responsibilities chart was updated. Facility rates for dental procedures under general anesthesia — in ambulatory surgery centers (ASCs) and outpatient hospitals — remain elevated to improve access, with a specific focus on pediatric and special needs patients.

Dental coverage by benefit plan for 2026:

Note: In FY 2023–24, the Michigan Legislature earmarked $80 million to increase the Medicaid dental provider fee schedule, improving provider participation and patient access.

Therapy, Laboratory, and Ambulance Fee Schedules

Beyond physician and behavioral health services, Michigan’s 2026 fee schedule updates also cover therapy, clinical lab, and ambulance reimbursement.

Each of these areas received targeted updates to reflect rising costs and improved access goals.

Therapy Services (PT, OT, Speech)

Michigan Medicaid fee schedules for physical therapy (PT), occupational therapy (OT), and speech therapy services are updated every January.

The most recent therapy schedule update was published on January 22, 2026.

Clinical Laboratory

Michigan Medicaid aligns with the CMS 2026 Clinical Laboratory Fee Schedule (CLFS). A 0% payment reduction is locked in through January 30, 2026, preventing cuts to lab reimbursement rates in the early part of the year.

Payment reductions are capped at 15% for each year 2026 through 2028, with the January 1–March 31, 2026 period as the reporting window.

Ambulance

The 2026 Ambulance Fee Schedule files (updated February 19, 2026) regulate payments based on geographic ZIP codes across Michigan.

Non-Emergency Medical Transportation (NEMT) remains a no-cost service for Medicaid beneficiaries, with reimbursement paid directly to providers.

Auto No-Fault Medical Fee Schedule 2026

Michigan’s Auto No-Fault Medical Fee Schedule is adjusted annually for inflation, and the 2026 update is significant for hospitals, clinics, and rehabilitation centers treating crash survivors.

2026 Inflation Adjustment

A 13.12% increase applies to all payable fee caps for services rendered to auto accident victims in 2026.

This adjustment is based on the Consumer Price Index (CPI) and is mandated by Michigan’s post-reform auto insurance code.

The official adjustment is confirmed in DIFS Bulletin 2026-XX-INS.

This increase helps providers keep pace with medical inflation, making it easier to treat injured motorists while remaining financially sustainable.

Workers’ Compensation Fee Schedule 2026

Michigan’s Workers’ Compensation fee schedule is administered separately by the Workers’ Disability Compensation Agency (WDCA) through its Health Care Services Rules, updated annually.

Key 2026 Change: 42-Day Drug Dispensing Limit

A critical new rule for 2026 limits reimbursement for physician-dispensed medications to 42 days from the start of care. After this window, prescriptions must be filled at a licensed pharmacy.

This change is designed to control costs and improve transparency in drug dispensing within the workers’ comp system.

Home Help Provider Rates 2026

Michigan Medicaid Home Help providers received a rate increase for 2026, supporting in-home care for elderly and disabled beneficiaries.

These rates are set by MDHHS and apply to both individual and agency providers.

Pharmacy: GLP-1 Weight-Loss Drug Restrictions

Effective January 1, 2026, Michigan Medicaid has placed new restrictions on GLP-1 weight-loss drugs, including Wegovy and Zepbound.

These drugs are no longer covered without meeting specific criteria under the updated Medicaid pharmacy policy.

Providers and patients should verify coverage requirements through CHAMPS or by contacting the MDHHS Provider Inquiry Line.

Michigan Medicaid Rates vs. Medicare

Understanding how Michigan compares nationally helps providers and policymakers evaluate access to care.

Across all states, Medicaid payments to providers average less than 75% of Medicare reimbursement rates — and often less than what private insurers pay.

Low reimbursement discourages providers from enrolling in Medicaid. Approximately one in three U.S. physicians refuse to accept any Medicaid patients.

Michigan’s FY2025 Medicaid Rate Comparison Study (September 30, 2025) formally recommended rate increases across access-limiting CPT codes heading into 2026 budget deliberations.

To see how Michigan stacks up against other states, review the Medicaid income limits by state in 2026 data, which outlines eligibility thresholds that affect enrollment and provider caseloads.

Fee-for-Service vs. Managed Care in Michigan

Michigan Medicaid operates under two delivery models. Understanding which model a patient falls under determines how providers get paid.

Fee-for-Service (FFS): MDHHS pays providers directly using the published fee schedules. All billing is processed through CHAMPS.

Managed Care / Medicaid Health Plans (MHPs): Rate increases apply to all FFS and managed care providers. Managed care plans may pay contracted providers at or above the MDHHS floor rates.

Prepaid Inpatient Health Plans (PIHPs): PIHPs are paid through capitated rates and may vary payment amounts for contracted providers.

Programs Covered by Michigan’s 2026 Fee Schedules

Michigan’s provider fee schedules cover the following programs:

• Medicaid (full benefit)
• Healthy Michigan Plan (Medicaid expansion for adults 19–64)
• Children’s Special Health Care Services (CSHCS)
• MIChild
• Maternity Outpatient Medical Services (MOMS)
• Other MDHHS-administered health care programs

How to Look Up 2026 Michigan Medicaid Rates

State fee schedules are large databases, not single PDF files. Use these official portals to find specific procedure codes (CPT/HCPCS):

1. CHAMPS Portal — Log in at michigan.gov/mdhhs → Medicaid Providers → CHAMPS
2. Medicaid Code and Rate Reference Tool — Available inside CHAMPS External Links; provides real-time procedure-code-level rates
3. MDHHS Provider Inquiry Line — 📞 1-800-292-2550 (toll-free)
4. Email Support — providersupport@michigan.gov
5. Fee Schedule Downloads — michigan.gov/mdhhs → Billing & Reimbursement → Information Specific to Different Providers
6. Workers’ Comp — Visit the WDCA Health Care Services page for the full Rule Set

Official Policy Note: If any discrepancy exists between the fee schedule posted online and the Michigan Medicaid Provider Manual, the Provider Manual language controls.

Frequently Asked Questions (FAQs)

Official Sources

• 🔗 Michigan MDHHS Provider Billing & Reimbursement
• 🔗 CMS CY 2026 Physician Fee Schedule Final Rule — CMS.gov
• 🔗 MDHHS Medicaid Reimbursement Rates Report, Public Act 121 of 2024 (September 30, 2025)
• 🔗 Michigan Health & Hospital Association — mha.org
• 🔗 WDCA Health Care Services Rules — michigan.gov/leo

Last Updated: February 20, 2026 | Content reviewed against MDHHS, CMS, and Michigan MHA official sources. Always verify current rates directly through CHAMPS or the MDHHS Provider Manual.