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

Feb 24, 2023

This message is a follow up to our January 17, and February 2, 2023 billing guidance regarding rate study increases for Sections 28 and 65. Since then, we have made additional systems changes to allow claims to process properly in accordance with our guidance. With those changes now in place, providers can follow the guidance shared on February 2, copied again below. We apologize for the inconvenience and delay. 

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.  

If you have any questions, please contact your Provider Relations Specialist, Pamela Grotton.