McLaren Health Plan follows the claims reimbursement policies and procedures set forth by MDHHS and CMS. Reimbursement for Medicaid and Medicare is based on the prevailing State of Michigan Medicaid or Medicare fee schedule.

Following a post-adjudication audit, McLaren Health Plan identified claims that were inappropriately reimbursed when billed with modifiers 93 or 95, which indicates the virtual care method used. The Michigan Department of Health and Human Services (MDHHS) telemedicine fee schedules identify the codes which are payable when billed with modifiers 93 or 95. McLaren found payments associated to service codes not on the published telemedicine fee schedules. Dates of services impacted are from 1/1/2024 -7/31/2025.

Click here to read the full initiative description sent out by McLaren Health Plan. These notifications are also posted on the McLaren website.