Michigan

Here you will find Michigan-specific elements relative to your use of PIP Fee.

    Effective Date and Scope

  • Pre–July 2, 2021, Services: Services provided before July 2, 2021, are reimbursed under the prior framework and are not capped by the new schedule.
  • Post–July 1, 2021, Services: All treatment dates of service after July 1, 2021, are subject to the fee schedule caps.

    • How the Fee Schedule Works

  • Medicare Benchmarking: For services with a Medicare code, reimbursement is tied to a percentage of the Medicare fee schedule. The percentage decreases over time, beginning at 200% in 2021–2022 and tapering in later years.
  • Non-Medicare Services: Where no Medicare rate exists, the statute imposes a cap based on the provider’s previous charges.

    • See how to use the CDM field in PIP Fee ›

  • Ongoing Adjustments: Providers and insurers must track the statutory percentage for the applicable calendar year to ensure compliance.

    • Practical Implications

  • Providers: Must align billing practices with the statutory caps or risk partial denials.
  • Insurers: Must apply the correct fee schedule limitations in adjusting claims and defending against overbilling.
  • Attorneys: Should anticipate disputes where providers exceed caps, where no Medicare equivalent exists, or where historical charge data is contested.

    • Streamlining the Process with PIP Fee

    The statutory framework is complex, and manual application of the fee schedule is unbearably time-consuming and error-prone. PIP Fee does the heavy lifting for you:

  • Instantly applies the correct fee schedule based on the date of service.
  • Accounts for Medicare-linked and non-Medicare services alike.
  • Provides accurate reimbursement calculations that help providers bill correctly and insurers evaluate claims confidently.

    • In short: PIP Fee ensures compliance with Michigan’s no-fault reform—without the guesswork. Sign up today.

    When to Use It

    The CDM price is only required when:

  • The code you entered is not found in any fee schedule; and
  • You have the official CDM price from January 1, 2019.

    • If you don’t have the CDM price, leave the field blank. The system will automatically calculate the amount by multiplying your Net Charge (Gross Charge − Adjustment) using the percentages in MCL 500.3157(7).

    What Happens When You Use It

  • If left blank:
    The system uses Net Charge × 3157(7) percentage to determine the allowed amount.
  • If filled in:
    The system ignores the Net Charge and instead uses CDM Price × 3157(7) percentage.

    • Example

  • Gross Charge: $1,000
  • Adjustment: $100
  • Net Charge: $900
  • CDM Price (Jan. 1, 2019): $800

    • If CDM Price is left blank → $900 × percentage from MCL 500.3157(7).
    If CDM Price is filled in → $800 × percentage from MCL 500.3157(7).