Michigan Medicaid Fee Schedule in 2026

Last updated: July 10, 2026 Primary source check: MDHHS bulletins, Michigan state plan filings, and 42 CFR § 447.203

There is no single PDF called the “2026 Michigan Medicaid Fee Schedule.” Rates live in two places. One is a set of spreadsheet files posted by MDHHS. The other is a live lookup tool inside CHAMPS.

To get an exact 2026 rate for a CPT or HCPCS code, you must look that code up yourself. The Medicaid Code and Rate Reference tool inside CHAMPS holds the current fee screens. MDHHS also posts a January 2026 spreadsheet for physicians, practitioners, and medical clinics.

One warning up front. Several websites claim Michigan Medicaid raised practitioner rates 2.5% on January 1, 2026. No MDHHS bulletin, state plan amendment, or public notice says this.

That 2.5% figure comes from the federal Medicare Physician Fee Schedule. It is not a Michigan Medicaid rate change. We explain the mix-up further down.

Article Summary

• No master rate book exists. MDHHS posts fee schedules as spreadsheets and keeps live rates in the CHAMPS Medicaid Code and Rate Reference tool.
• Home Help rates rose January 1, 2026. Individual caregivers now earn $17.13 per hour. Agency providers stay at $27.00 per hour. Both include a $3.40 pass-through.
• Bulletin MMP 26-03 (issued January 22, 2026) adopted new CPT and HCPCS codes for dates of service on or after January 1, 2026.
• Bulletin MMP 26-15 (issued May 1, 2026) added codes effective April 1, 2026, plus some retroactive dental coverage.
• The widely reported “2.5% Michigan Medicaid increase” is not supported by any state source. It is a Medicare figure.
• A federal deadline hit July 1, 2026. States must now publish all fee-for-service rates on a public website.

What the Michigan Medicaid Fee Schedule Actually Is

The fee schedule is the list of maximum amounts MDHHS pays for each service code. It applies to fee-for-service claims. Each line pairs a procedure code with a dollar amount called a “fee screen.”

The schedule is not one document. MDHHS splits it by provider type. Physicians get one file. Podiatrists get another. Labs, dentists, and behavioral health providers each have their own.

Fee Screens vs. Coverage Rules

A fee screen tells you the payment amount. It does not tell you whether a service is covered.

MDHHS is explicit about this. The modifier and age fields on a fee schedule apply to the fee screen only. They do not set coverage limits. For coverage rules, read the Medicaid Provider Manual.

The Provider Manual Wins

MDHHS states that its web pages are reference material. If a web page and the Provider Manual disagree, the Provider Manual controls. Always check the manual before you bill.

Fee-for-Service Is a Floor, Not the Whole Story

Most Michigan Medicaid members are in a managed care plan. Health plans may pay network providers more than the state fee schedule. MDHHS calls the published rates a “baseline.”

Specialty behavioral health services paid through Prepaid Inpatient Health Plans work differently again. Those payments are capitated. They do not appear on the fee schedule at all.

Where to Find Verified 2026 Rates

MDHHS keeps rate data in two official places. Neither one is a downloadable master list of every 2026 price. You have to search by code.

Below are the two paths, plus a step-by-step lookup you can follow today.

Path 1: The CHAMPS Medicaid Code and Rate Reference Tool

This is the authoritative source. It holds live data on rates, age limits, prior authorization flags, and billing indicators.

MDHHS updates this database at least once a year, and often more. It keeps a three-year history. Older schedules require a FOIA request.

Path 2: The Posted Fee Schedule Spreadsheets

MDHHS posts XLSX files under Billing & Reimbursement → Provider Specific Information. The Physicians/Practitioners/Medical Clinics page currently lists a January 2026 file. Older versions from October, July, and April 2025 sit alongside it.

These spreadsheets are useful for bulk review. They are still reference documents, not the final word.

How to Look Up a 2026 Rate: Step by Step

1. Log in to the CHAMPS portal with your provider credentials.
2. Open the External Links menu.
3. Select Medicaid Code and Rate Reference.
4. Enter the CPT or HCPCS code you want to check.
5. Set the date of service. Rates change by date, so this matters.
6. Read the fee screen, any PA requirement, and any age restriction.
7. Confirm coverage against the July 2026 Medicaid Provider Manual.

If a code will not resolve, call MDHHS Provider Inquiry at 1-800-292-2550. You can also email ProviderSupport@michigan.gov.

Verified 2026 Policy Bulletins

MDHHS announces changes through numbered policy bulletins. These are the primary sources. Everything below is drawn directly from them.

Each bulletin lists an issue date and an effective date. The two are rarely the same. Always bill by the effective date.

MMP 26-03: Annual Code Update (Issued January 22, 2026)

This bulletin adopted a large set of new HCPCS and CPT codes. They apply to dates of service on or after January 1, 2026.

It covers Medicaid, the Healthy Michigan Plan, Children’s Special Health Care Services, Maternity Outpatient Medical Services, and MI Coordinated Health. Affected providers include physicians, FQHCs, RHCs, THCs, podiatrists, oral surgeons, labs, CRNAs, audiologists, and nursing facilities.

Notable changes inside MMP 26-03:

• Vaccine counseling. Non-pharmacy providers now report CPT 90482–90484 when no vaccine is given that day. At least three minutes of counseling must be documented. Codes G0310–G0315 ended December 31, 2025.
• Hearing aids. Follow-up fitting now bills under CPT 92636/92637. Conformity evaluation bills under 92638/92639. V5011 and V5020 are no longer covered. Benefit maximums did not change.
• Collaborative Care. G0512 ended December 31, 2025. FQHCs, RHCs, and THCs now use CPT 99492, 99493, 99494, and HCPCS G2214. These pay outside the PPS rate.
• Diabetes prevention. MiDPP now aligns with HCPCS G9871 for asynchronous online delivery.

Important: MMP 26-03 is a coding bulletin. It contains no across-the-board rate percentage.

MMP 26-15: April Code Additions (Issued May 1, 2026)

This bulletin added new HCPCS codes for dates of service on or after April 1, 2026.

It also added retroactive coverage back to January 1, 2026 for dental codes D9244 and D9245. CPT 77387 was added retroactively for physicians, practitioners, and medical clinics.

Other 2026 Bulletins Affecting Payment

Bulletin	Date	Subject
MMP 26-02	Jan 2026	Fee-for-service prior authorization process; CHAMPS PA screens updated March 22, 2026
MMP 26-03	Jan 22, 2026	Annual CPT/HCPCS code updates for 2026
MMP 26-06	Feb 27, 2026	Hospital Rural Access Pool eligibility criteria
MMP 26-15	May 1, 2026	Coverage of new codes established April 1, 2026
MMP 26-17	Eff. Jul 1, 2026	Specialty behavioral health services location policy
MMP 26-20	Eff. Jul 1, 2026	Pharmacist-provided services (pending CMS approval)
MMP 26-22	Jun 1, 2026	July 2026 Provider Manual update

Home Help Rates: The Clearest 2026 Numbers

Home Help is the one area with plain, confirmed 2026 dollar figures. MDHHS published them in Adult Services Bulletin ASB 2026-002, issued December 1, 2025.

The change follows Michigan’s minimum wage increase for direct care workers under Public Act 337 of 2018. The state minimum wage rate for these workers rose to $13.73 per hour.

Provider Type	Base Rate	Pass-Through	Total Hourly Rate
Individual caregiver	$13.73	$3.40	$17.13
Agency provider	$23.60	$3.40	$27.00

Both rates took effect January 1, 2026.

You may see other numbers online. Some sites list $15.92 for individuals and $27.06 for agencies. Those figures are contradicted by MDHHS. Use the bulletin.

How Michigan Sets Practitioner Rates

Michigan does not invent rates from scratch. It benchmarks many of them against Medicare.

The state plan sets certain practitioner rates as a percentage of Medicare rates published each January. This is why Medicare news gets confused with Medicaid news so often.

The Percentage-of-Medicare Method

One state plan amendment, SPA 23-0023, sets psychiatric procedure reimbursement at 67.73% of the January Medicare rate. Other services use other percentages.

For Medicare benchmarking, Michigan uses the WPS J8 Medicare Contractor PAR rates. Those match Michigan’s “Rest of State” locality, not the “Detroit” locality.

A Separate Primary Care Schedule

Michigan also runs a Primary Care Fee Schedule. It applies to physicians with a primary specialty in family medicine, general internal medicine, pediatric medicine, or general practice. Qualified codes appear on a separate schedule with adjusted rates.

Where Michigan’s Rates Land

The most recent official analysis is the MDHHS Medicaid Reimbursement Rates Report, dated September 30, 2025. Researchers at the University of Michigan prepared it under Sec. 1975 of Public Act 121 of 2024.

Across the 40 studied CPT codes with a Medicare match, Michigan Medicaid averaged 72.8% of Medicare. Provider visits averaged 67.5%. Perinatal services averaged 79.7%.

Compared to three Midwest neighbors across all 50 codes:

State	Rates vs. Michigan
Illinois	2.0% higher
Minnesota	14.0% higher
Indiana	38.9% higher

Note the dating. That report used the April 2025 practitioner schedule and the January 2025 primary care schedule. These are not 2026 figures. No 2026 successor report has been published.

2026 Claims That Official Sources Do Not Support

Several sites rank well for this search and carry errors. We checked each against primary sources. Here is what we found.

We list these not to criticize, but because billing a claim on bad information costs real money.

Claim you may see online	What primary sources actually show
“Michigan Medicaid applied a 2.5% rate increase on Jan 1, 2026, with conversion factors of $33.40 and $33.58.”	These are Medicare figures. The CMS CY 2026 Physician Fee Schedule final rule implements a one-time 2.5% statutory increase from H.R. 1, with two conversion factors. No MDHHS bulletin, SPA, or notice states Michigan Medicaid applied a 2.5% increase.
“Home Help individual rates rose to $15.92/hour; agency rates to $27.06.”	Contradicted by MDHHS. ASB 2026-002 sets $17.13 and $27.00.
“Telehealth frequency limits were permanently removed for Michigan Medicaid in 2026.”	This is a Medicare CY 2026 policy. No MDHHS bulletin extends it to Michigan Medicaid.
“Michigan ranks 7th lowest nationally for behavioral health Medicaid rates.”	Unverified. The Sec. 1975 report compares Michigan only to Illinois, Indiana, and Minnesota. It contains no national ranking.
“MDHHS decoupled non-physician behavioral health payments effective Oct 1, 2025.”	That October 2025 change was made by Priority Health, a health plan, for its own payments. The MDHHS Non-Physician Behavioral Health Fee Schedule is long-standing, not new.
“Auto No-Fault fees rose 13.12%” / “Workers’ Comp limits dispensed drugs to 42 days.”	Not Medicaid. Auto No-Fault is regulated by DIFS. Workers’ Comp is regulated by the WDCA. Do not apply either to Medicaid billing.

The pattern is consistent. Federal Medicare policy gets relabeled as Michigan Medicaid policy. Read the bulletin before you trust the headline.

The Federal Rate Transparency Deadline

A federal rule now requires states to publish their Medicaid fee-for-service rates publicly. This changes how easy 2026 rates should be to find.

The rule comes from the Ensuring Access to Medicaid Services final rule. It was published April 22, 2024 and took effect July 9, 2024.

What 42 CFR § 447.203 Requires

Under the regulation, states must publish all fee-for-service rates on a public website. Initial publication was due no later than July 1, 2026. It must reflect approved rates in effect on that date.

States must also show when rates were last updated. They must refresh the publication within one month of a rate or methodology change.

The Comparison Requirement

States must also compare their fee-for-service rates against Medicare. The comparison covers primary care, obstetric and gynecological care, and outpatient mental health and substance use services. It repeats every two years.

CMS guidance sets the first comparative analysis due July 1, 2026, using CY 2025 rates.

Michigan’s Status

As of July 10, 2026, we could not confirm from any official Michigan source that MDHHS has posted its § 447.203 transparency publication or its comparative rate analysis. We found no MDHHS page or bulletin announcing compliance.

This is not a claim that Michigan failed to comply. It means we could not verify it. Contact MDHHS directly if you need confirmation.

2026 Budget Context

Rates do not change on their own. The Legislature funds them. Knowing which budget is in force keeps you from quoting a rate that does not exist yet.

Two fiscal years matter right now. Only one of them is law.

FY 2025-26: Currently in Effect

This budget year runs October 1, 2025 through September 30, 2026. Boilerplate holds the Medicaid reimbursement rate for injectable and oral vaccines at $23.03. Nasally administered vaccines became eligible for the same rate.

FY 2026-27: Proposals Only

This budget begins October 1, 2026. As of July 10, 2026, it is not enacted. Every number below is a proposal.

The Senate version raises the base FMAP from 65.30% to 65.70%. It raises the CHIP match from 75.71% to 75.99%. It includes $658.1 million gross for managed care actuarial soundness adjustments.

Proposed actuarial adjustments include 3.0% for PIHPs, 5.0% for Medicaid health plans, 3.5% for PACE, 6.8% for MI Choice, and 4.3% for Integrated Care Organizations. Dental sits at 1.3%.

Boilerplate proposals include an autism behavioral technician rate and a methadone bundled rate for H0020 at not less than $19.00. The direct care worker wage increase of up to $3.40 per hour continues.

Do not bill against these numbers. They are not effective rates.

2026 Eligibility Basics for Michigan Patients

Eligibility is separate from the fee schedule. But providers ask about it constantly, so here is the short version.

Michigan Medicaid rules vary by program. There is no single income limit that covers everyone.

Program-by-Program Limits

Healthy Michigan Plan adults qualify at 138% of the Federal Poverty Level. Children qualify at higher thresholds. Pregnant women have their own limit.

Asset rules differ too. Aged, Blind & Disabled Medicaid uses a $2,000 individual asset limit. Nursing home Medicaid and HCBS waivers use $9,950.

For exact current figures, use MI Bridges or call the MDHHS Beneficiary Helpline at 1-888-642-4845.

Households Often Qualify for More Than One Program

Many Medicaid households also receive food assistance. The two programs use different income tests, so qualifying for one does not guarantee the other. If you are helping a patient sort out what else they may be eligible for, our guide to SNAP income limits by state in 2026 shows how thresholds differ from Medicaid’s.

MI Coordinated Health

On January 1, 2026, the MI Coordinated Health program replaced MI Health Link. It combines Medicare and Medicaid benefits for dually eligible residents into one delivery system. MMP 26-03 lists MI Coordinated Health among the programs it applies to.

What We Could Not Verify

Honest reporting means naming the gaps. These items had no confirmable 2026 source as of July 10, 2026.

We would rather tell you the data is missing than guess at it.

• No across-the-board 2026 percentage change to Michigan Medicaid practitioner rates appears in any MDHHS bulletin, SPA, or notice we could access.
• No accessible code-level 2026 dollar amounts outside the XLSX files and CHAMPS.
• No current percentage-of-Medicare multiplier for 2026. The 67.73% figure comes from a 2023 filing.
• No 2026 successor to the Sec. 1975 rate comparison report.
• No verified 2026 rates for nursing facilities, inpatient hospital DRG, Healthy Kids Dental, ambulance, or clinical laboratory in any narrative source.
• No confirmation of Michigan’s § 447.203 compliance publication.
• No verified GLP-1 coverage restriction in a 2026 MDHHS bulletin, despite widespread reporting.

Frequently Asked Questions

Did Michigan Medicaid raise rates 2.5% in 2026? No MDHHS source says so. The 2.5% increase is a federal Medicare Physician Fee Schedule change from H.R. 1. Websites reporting it as Michigan Medicaid policy are conflating Medicare with Medicaid.

Where do I find the exact 2026 rate for a CPT code? Use the Medicaid Code and Rate Reference tool inside CHAMPS, under the External Links menu. It shows live fee screens by date of service. MDHHS also posts a January 2026 XLSX for practitioners.

What is the 2026 Home Help rate in Michigan? Individual caregivers earn $17.13 per hour. Agency providers earn $27.00 per hour. Both totals include a $3.40 pass-through and took effect January 1, 2026, per ASB 2026-002.

Why do managed care plans pay differently than the fee schedule? The fee schedule sets fee-for-service rates only. MDHHS calls it a baseline. Medicaid Health Plans may pay network providers above those rates. Behavioral health paid through PIHPs is capitated instead.

Which 2026 bulletins changed billing codes? MMP 26-03, issued January 22, 2026, adopted new CPT and HCPCS codes effective January 1, 2026. MMP 26-15, issued May 1, 2026, added codes effective April 1, 2026, plus retroactive dental coverage.

Who do I call when a code will not resolve in CHAMPS? Call MDHHS Provider Inquiry at 1-800-292-2550. You can also email ProviderSupport@michigan.gov. Confirm coverage against the July 2026 Medicaid Provider Manual, which controls over web pages.

Official Sources

• MDHHS — Physicians/Practitioners/Medical Clinics fee schedules: michigan.gov/mdhhs
• MDHHS — Information Specific to Different Providers: michigan.gov/mdhhs
• 42 CFR § 447.203 — Documentation of access to care and payment rates: ecfr.gov
• CMS — Ensuring Access to Medicaid Services guidance: medicaid.gov
• MDHHS — Adult Services Bulletin ASB 2026-002 (Home Help rates): mdhhs-pres-prod.michigan.gov

What to Do Next

Do not bill from a blog post. Not this one either.

Open CHAMPS, look up your codes against the actual date of service, and check the July 2026 Provider Manual for coverage rules. If a number does not match what you expected, call Provider Inquiry at 1-800-292-2550 before you submit.

Five minutes of verification beats a denied claim. Go check your codes.

This article is for informational purposes only. It is not legal, financial, or billing advice. Michigan Medicaid rules change often, and rates vary by program, provider type, and date of service. Always verify current requirements directly with MDHHS.