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MDCH Issues Physician Injectable Drug Coverage Policy

Friday, March 14, 2014  
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The Michigan Department of Community Health (MDCH) recently issued MSA bulletin 14-05 to clarify the policy for billing and reimbursement of physician-administered psychotropic injectable drugs in the outpatient setting that are carved out of Medicaid Health Plan (MHP) coverage.

This policy affects Michigan Health Centers in that physicians not associated with a Pre-Paid Inpatient Health Plan (PIHP)/Community Mental Health Services Program (CMHSP) and who are administering an injectable psychotropic carve-out drug in an outpatient setting to MHP enrollees must notify the beneficiary’s MHP and primary care provider. The carve-out drugs covered by MDCH through Fee for Service (FFS) should be billed using the physicians’ NPI through CHAMPS. The FFS reimbursement by MDCH to physicians not associated with a PIHP/CMHSP is limited to carve-out drugs only. Physicians can then bill the MHP for any additional services.

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