Implementation of January 1, 2023 Rate Study Increases for Sections 28 and 65 

Feb 02, 2023

As of yesterday, February 1, 2023, updated rates, modifiers and/or units for Sections 28 and 65 are now available for billing in MIHMS. These changes will be effective retroactive to January 1, 2023, and result from our recent rate studies conducted in relation to P.L. 2021 Ch. 398, Pt. AAAA; Ch. 635, Pt JJJ; and Ch. 639. New rates will apply only to services provided on or after January 1, 2023.  

The Department will issue additional guidance on billing and authorizations for services within these sections later this week.  The guidance will focus on questions related to the Kepro prior authorization process, and service expectations related to billing, particularly for those services with modifier and unit changes. 

Section 28: 

• For Section 28 services delivered on January 1, 2023 or later and NOT yet billed, updated rates and modifier combinations are now available for billing in MIHMS and will pay at the updated rates.  

• For Section 28 services delivered on January 1, 2023 or later and ALREADY billed with the rates that were in effect PRIOR to January 1, 2023, providers may now adjust those claims to indicate the new rates and modifier combinations. The Department will reconcile payments between the new and old rates retroactive to January 1, 2023. Detailed instructions for claims adjustment can be found here. 

View the new Section 28 rates.  

Section 65: 

• For Section 65 services delivered on January 1, 2023 or later and NOT yet billed, updated rates, modifiers and units are now available for billing in MIHMS and will pay at the updated rates.  

• For Section 65 services delivered on January 1, 2023 or later and ALREADY billed with the NEW rates now in effect as of January 1, 2023, for which there were NO CHANGES to modifiers or units, the Department will now adjust claims on behalf of providers to pay the differential to the increased amounts retroactive to January 1, 2023.   

• For Section 65 services delivered on January 1, 2023 or later and ALREADY billed with the rates in effect PRIOR to January 1, 2023, that DID HAVE changes to units or modifiers, providers may now adjust those claims to indicate the new rates, modifiers, and/or units. The Department will reconcile payments between the new and old rates retroactive to January 1, 2023. Detailed instructions for claims adjustment can be found here.*  

View the new Section 65 rates. 

*Note: Initial guidance on rate implementation changes for Section 65 instructed providers to use modifier U1 to designate outpatient services ‘community’ level of care. That was an error, and OMS now asks that providers utilize U2 for outpatient services provided in the community.  

If you have any questions, please refer to the guidance forthcoming this week, and/or contact your Provider Relations Specialist, Pamela Grotton.