Michigan Therapist Billing: OON Superbills and Insurance
Michigan-specific guide for LPCs, LMSWs, and LMFTs — BCBS Michigan dominance, Priority Health, 5-year lookback rules, and OON rates by metro.
2026-03-28 · 6 min read · By The Superbilled Team
Michigan has roughly 22,000 licensed mental health professionals serving 10 million residents. Blue Cross Blue Shield of Michigan (BCBSM) is the undisputed dominant insurer — over 4.5 million members — and its unique 5-year billing lookback policy makes clean recordkeeping critical for every OON therapist in the state.
Michigan License Types and Billing
The Michigan Department of Licensing and Regulatory Affairs (LARA) issues the following license types that can independently bill insurance for psychotherapy:
- LPC— Licensed Professional Counselor (Michigan's fully independent counselor credential)
- LMSW — Licensed Master Social Worker (clinical designation)
- LMFT — Licensed Marriage and Family Therapist
- Licensed Psychologist — Doctoral level
Michigan uses "LPC" for its fully independent counselor credential (not LPCC as in some other states). Your Michigan license number, NPI, and taxonomy code must appear on every superbill.
Out-of-Network Therapy in Michigan: The Landscape
Michigan's OON market is anchored by metropolitan Detroit (Wayne, Oakland, and Macomb counties), Ann Arbor (home to the University of Michigan), Grand Rapids, and East Lansing. The Detroit metro has the highest rate concentration, driven by automotive industry professionals and suburban corporate employer plans. Ann Arbor supports premium OON rates due to the academic and healthcare professional demographic. Grand Rapids is a growing mid-size market with strong faith-based therapy demand.
Dominant Insurance Carriers in Michigan
- Blue Cross Blue Shield of Michigan (BCBSM)— The overwhelmingly dominant insurer in Michigan. BCBSM covers more than 4.5 million Michiganders and processes the majority of commercial health claims in the state. PPO plans (including Blue Preferred PPO and Blue Preferred Plus PPO) include OON mental health benefits. BCBSM's critical distinction: it maintains a 5-year billing record lookback and can audit superbills submitted up to 5 years after service. Therapists must retain session records and billing documentation for at least 5 years. OON claims submitted to BCBSM through the member portal at bcbsm.com typically process within 30–45 days.
- Priority Health — Michigan-based insurer with strong presence in West Michigan and Grand Rapids. Priority Health PPO plans include OON benefits. Their HMO plans (Priority Health Choice) typically do not cover OON mental health services.
- Aetna — Common in Michigan corporate employer plans. Standard OON PPO benefits; clients submit via the Aetna member portal.
- UnitedHealthcare — Significant employer-group presence across metro Detroit and Ann Arbor. OON claims through myuhc.com.
- McLaren Health Plan — Michigan-based regional insurer. Commercial PPO plans include OON mental health benefits. Strong presence in Flint, Saginaw, and northern lower Michigan.
- Michigan Medicaid (Healthy Michigan Plan) — Does not offer OON psychotherapy benefits. Managed care plans contract with network providers only.
Typical OON Reimbursement Rates in Michigan
| CPT Code | Detroit Metro / Oakland County | Ann Arbor | Grand Rapids | Lansing / Other |
|---|---|---|---|---|
| 90837 (60 min) | $145–$170 | $150–$175 | $130–$155 | $120–$145 |
| 90834 (45 min) | $115–$140 | $120–$145 | $105–$125 | $95–$115 |
| 90832 (30 min) | $80–$105 | $85–$110 | $75–$95 | $70–$90 |
| 90791 (intake) | $175–$220 | $180–$225 | $160–$200 | $150–$185 |
State-Specific Billing Regulations
- Mental health parity. Michigan enforces the federal MHPAEA. The Michigan Department of Insurance and Financial Services (DIFS) investigates parity violations; clients can file at michigan.gov/difs.
- Telehealth parity. Michigan enacted telehealth parity legislation requiring commercial insurers to reimburse telehealth mental health services at parity with in-person services. Use Place of Service 10 on superbills for telehealth sessions. Michigan also covers audio-only telehealth for mental health.
- BCBSM 5-year lookback. Blue Cross Blue Shield of Michigan retains the right to audit OON claims and request supporting documentation for up to 5 years after the date of service. All session notes, billing records, and superbill copies should be retained for a minimum of 5 years.
- Good Faith Estimates. Michigan therapists must provide GFEs to self-pay clients per the No Surprises Act. See our Good Faith Estimate guide.
Tips for Michigan Therapists
- The BCBSM 5-year rule is non-negotiable. Unlike most insurers with 12–24 month lookbacks, BCBSM Michigan can request claim documentation years later. Store session notes and superbill copies in a HIPAA-compliant system with at least 5 years of retention.
- Distinguish BCBSM from BCBS Federal Employee Program. Federal employees in Michigan often carry the Blue Cross Blue Shield Federal Employee Program (FEP), which is administered separately from BCBSM. FEP has different OON benefit structures and claim submission processes.
- Priority Health HMO vs. PPO. Priority Health offers both HMO and PPO products. HMO members typically have no OON mental health benefit. Ask clients to verify their plan type before assuming superbill reimbursement is possible.
- Ann Arbor supports premium OON rates. The University of Michigan healthcare ecosystem and academic/tech professional demographic in Ann Arbor supports session fees at the high end of Michigan ranges ($165–$200+).
- Telehealth reaches the Upper Peninsula.Michigan's Upper Peninsula has severe therapist shortages. An OON telehealth practice can serve UP residents who carry employer PPO plans and would otherwise have no access to OON care.
Generate Your Michigan Superbill
Superbilled generates HIPAA-compliant superbill PDFs for Michigan-licensed LPCs, LMSWs, LMFTs, and psychologists. Visit our Michigan superbill generator to create your practice profile and generate superbills in under 60 seconds.