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Michigan No-Fault Fee Schedule

Editorial Board member, Katie Tucker, explains the “Fee Schedule” that applies to medical providers under the amended version of the Michigan No-Fault Act.

Fee Schedule General Overview

What is the new “fee schedule”?

The “fee schedule” refers to a series of new reimbursement limitations set forth in the amended version of the No-Fault Act for treatment rendered to an individual relative to injuries sustained in an auto accident for which he or she is eligible for no-fault benefits. Importantly, the “fee schedule” is actually a series of “caps” on provider reimbursement, rather than a series of guaranteed (or scheduled) payments by no-fault insurers. In addition to these new reimbursement “caps,” the “reasonable” and “customary” limitations on a providers’ charges for auto accident-related treatment, which have long been a feature of Michigan’s no-fault system, remain intact in the amended version of the statute. See MCL 500.3157(1).

What governs the new “fee schedule”?

As noted above, the “fee schedule” is primarily governed by and creation of the amended version of the No-Fault Act, which became effective when Public Act 21 was signed into law on June 11, 2019. More specifically, the “fee schedule” is set forth in and governed by the post-amendment version of MCL 500.3157, which can be accessed here: MCL 500.3157.

In addition, the “fee schedule” is also subject to and governed by a series of administrative rules promulgated by the Department of Insurance and Financial Services (“DIFS”), which are known as the No-Fault Fee Schedule Rules and which became effective on October 1, 2021. These Rules can be accessed here: No-Fault Fee Schedule Rules.

When did the new “fee schedule” take effect?

The “fee schedule” took effect as of July 2, 2021, which is the first date to which the new reimbursement limitations apply. Specifically, these limitations apply to “treatment or rehabilitative occupational training rendered after July 1, 2021.” See MCL 500.3157(14).

To what providers does the new “fee schedule” apply?

Under the plain language of the statute, the “fee schedule” applies to “a physician, hospital, clinic, or other person” that “renders treatment or rehabilitative occupational training to an injured person for an accidental bodily injury covered by personal protection insurance.” Notably, however, the “fee schedule” does not apply to “emergency medical services rendered by an ambulance operation” as defined by the Public Health Code. See MCL 500.3157(13).