Michigan Medicaid (MDHHS fee-for-service) Outpatient Physical Therapy prior authorization requirements (2026)
What Michigan Medicaid (MDHHS fee-for-service) generally requires to approve Outpatient Physical Therapy (CPT 97161, 97162, 97163, 97164, 97110, 97112, 97113, 97116, 97124, 97140, 97150, 97530, 97535, 97542, 97750, 97760, 97761, 97010, 97012, 97014, 97032, 97035), for Medicaid plans. Based on the cited policy, Michigan Medicaid (MDHHS fee-for-service) does not generally require prior authorization for Outpatient Physical Therapy (CPT 97161, 97162, 97163, 97164, 97110, 97112, 97113, 97116, 97124, 97140, 97150, 97530, 97535, 97542, 97750, 97760, 97761, 97010, 97012, 97014, 97032, 97035). Confirm with Michigan Medicaid (MDHHS fee-for-service), as this can vary by plan.
Medical-necessity criteria Michigan Medicaid (MDHHS fee-for-service) generally applies
No prior authorization up to the standard limits: Michigan Medicaid fee-for-service covers rehabilitative (or habilitative) outpatient PT up to 144 units per calendar year, and maintenance therapy up to 4 visits/16 units per 90 days. PRIOR AUTHORIZATION IS REQUIRED for treatment exceeding those limits regardless of diagnosis - submit form MSA-115 through CHAMPS (Program Review Division) at least 3 weeks before the limits are reached; verbal PA is possible for urgent cases; no retroactive PA; authorizations may cover up to 6 months. Medicaid Health Plans (MCOs) set their own PA rules - check the member's plan (e.g., Meridian routes PT through Evolent).
Commonly required documentation
- Evaluation/re-evaluation with objective measures
- summary of the prior treatment period
- measurable functional goals
- prescription
- signed plan of care
- GN/GO/GP therapy modifiers (96/TS for habilitative/maintenance)
- MSA-115 via CHAMPS when exceeding limits.
How to submit
- Method: CHAMPS Direct Data Entry (form MSA-115) when PA is required
- Portal: CHAMPS
Sources & verification
Sources: MDHHS Outpatient Therapy Guide MDHHS Medicaid Provider Manual (Therapy Services). [NEEDS CLINICAL SPOT-CHECK] View the source policy. Last verified 2026-07-09.
Frequently asked questions
Does Michigan Medicaid (MDHHS fee-for-service) require prior authorization for Outpatient Physical Therapy?
Based on the cited policy, Michigan Medicaid (MDHHS fee-for-service) does not generally require prior authorization for Outpatient Physical Therapy (CPT 97161, 97162, 97163, 97164, 97110, 97112, 97113, 97116, 97124, 97140, 97150, 97530, 97535, 97542, 97750, 97760, 97761, 97010, 97012, 97014, 97032, 97035). Confirm with Michigan Medicaid (MDHHS fee-for-service), as this can vary by plan.
What does Michigan Medicaid (MDHHS fee-for-service) require to approve Outpatient Physical Therapy?
No prior authorization up to the standard limits: Michigan Medicaid fee-for-service covers rehabilitative (or habilitative) outpatient PT up to 144 units per calendar year, and maintenance therapy up to 4 visits/16 units per 90 days. PRIOR AUTHORIZATION IS REQUIRED for treatment exceeding those limits regardless of diagnosis - submit form MSA-115 through CHAMPS (Program Review Division) at least 3… Always confirm against the current Michigan Medicaid (MDHHS fee-for-service) policy.
How long does a Michigan Medicaid (MDHHS fee-for-service) prior authorization take?
Turnaround varies by plan and submission method. Check the Michigan Medicaid (MDHHS fee-for-service) portal for current timeframes.
Submitting Outpatient Physical Therapy to Michigan Medicaid (MDHHS fee-for-service)?
Praxigen checks your clinical note against these criteria before you submit and drafts a policy-cited appeal if it is denied. You review and submit; nothing is sent automatically.