MCL 500.3157: Medicare Caps, Attendant Care, and 12% Interest

Michigan’s no-fault fee schedule, set out in MCL 500.3157, caps what medical providers can charge an auto insurer for treating someone hurt in a car crash. For services with a Medicare billing code, the ceiling is a percentage of what Medicare would pay — 190%, 220%, or 230% depending on the type of facility. For services with no Medicare code, the ceiling is a percentage of the provider’s own price list as it stood on January 1, 2019. The schedule took effect July 1, 2021 and reached its final rates on July 1, 2023.¹

The Reasonableness Ceiling Comes First

Before the percentage caps ever come into play, a provider’s charge to an auto insurer cannot exceed what that provider ordinarily bills patients whose care is not covered by auto insurance. If a clinic charges $150 for an office visit to a cash-paying patient, $150 is the ceiling for a no-fault claim. A provider cannot mark up prices because an auto policy is paying.¹

The rule reaches physicians, hospitals, clinics, and anyone else lawfully providing treatment or rehabilitative occupational training. Insurers audit billing records to confirm no-fault charges match the provider’s standard price list, and mismatches drive most fee disputes into litigation.

Medicare-Based Caps by Provider Type

Where a service has a Medicare billing code, MCL 500.3157 sets the maximum as a percentage of the Medicare rate. Three tiers apply, and the current rates have been in place since July 1, 2023.¹

Standard Providers: 190% of Medicare

Most physicians, clinics, and hospitals fall here. Their reimbursement is capped at 190% of what Medicare would pay for the same service.

Qualifying Hospitals and Freestanding Rehab Facilities: 220% of Medicare

A hospital moves up a tier if, on July 1 of the year treatment is provided, at least 20% but less than 30% of its patient volume is indigent, measured by the methodology the Michigan Department of Health and Human Services uses for Medicaid disproportionate share payments. Up to two designated freestanding rehabilitation facilities also qualify. These providers can be reimbursed up to 220% of Medicare.

Level I and Level II Trauma Centers: 230% of Medicare

Hospitals verified as Level I or Level II trauma centers by the American College of Surgeons Committee on Trauma sit at the top tier, with a cap of 230% of Medicare.

Geographic Adjustments Ride Along

Medicare does not pay the same amount everywhere. It applies geographic practice cost indices that account for regional differences in labor costs, practice expenses, and malpractice premiums, and CMS updates them annually.² Because the statute ties the cap to the amount payable under Medicare, the geographic adjustment flows through. A provider in Detroit and one in rural northern Michigan billing the same procedure can end up with different reimbursements.

Services With No Medicare Code

Some treatments and equipment simply have no Medicare billing code. This is common with specialized rehabilitation technology, custom prosthetics, and certain residential care programs. For those services, the statute does not use Medicare at all. It freezes reimbursement to a percentage of the provider’s own prices as they existed on January 1, 2019.¹

The reference document is the provider’s charge description master, its internal list of prices for every service and supply. The percentage applied to the 2019 price depends on the provider tier:

Standard providers: 52.5% of the January 1, 2019 charge.
Qualifying hospitals and freestanding rehab facilities: 66.5%.
Level I/II trauma centers: 71%.

The cut is steep. A standard provider that charged $1,000 for a non-coded service in 2019 can collect a maximum of $525 for that same service today, no matter how much prices have moved since.

If a provider did not maintain a charge description master on January 1, 2019, the fallback is the average amount the provider actually charged for the service on that same date. Providers must be able to document those historical prices. When they cannot, Michigan’s administrative rules allow the Department of Insurance and Financial Services to consult the FAIR Health benchmarking database for the average charge in the provider’s geographic area.³

What Triggers the Fee Schedule: Date of Treatment, Not Date of Crash

Subsection 14 applies the fee schedule to “treatment or rehabilitative occupational training rendered after July 1, 2021.”¹ The date of the medical service controls, not the date of the accident. Someone injured in 2015 who is still receiving ongoing care has that current care billed under the schedule, even though the crash predates the reform by years. This caught many long-term care patients and their providers off guard when the schedule took effect, because reimbursement dropped significantly while the underlying treatment plan did not change.

The 56-Hour Cap on Family Attendant Care

When attendant care is provided in the injured person’s home by someone with a personal connection to them, the insurer is only required to pay for up to 56 hours per week. The cap applies where the caregiver is related to the injured person, lives in the same household, or had a business or social relationship with the injured person before the accident.¹

Attendant care covers help with daily needs like dressing, bathing, and managing medication. If round-the-clock supervision is needed, hours beyond 56 per week must come from a professional caregiver or agency, whose rates still fall under the fee schedule but not under the hourly cap. Keep detailed time logs; insurers deny hours over the weekly limit.

Subsection 11 leaves one opening. An insurer may voluntarily contract to pay for more than 56 hours per week of care from these individuals. It is not a right the injured person can demand, but an option the insurer can offer. The Michigan Department of Insurance and Financial Services confirmed when the reform passed that this voluntary expansion remained available even after the 56-hour cap took effect.⁴ Getting an insurer to agree usually requires documentation showing professional alternatives are unavailable or inadequate.

How the Schedule Interacts With PIP Coverage Levels

The 2019 reform let Michigan drivers choose lower levels of personal injury protection medical coverage, and the fee schedule keeps provider charges in check across every tier. The available choices are unlimited PIP, $500,000, $250,000, $50,000 (only if the policyholder is enrolled in Medicaid and all household members have other qualifying coverage), and no PIP medical coverage at all (only if the policyholder has Medicare Parts A and B and household members are otherwise covered).⁵

The fee schedule applies to all of these tiers. For anyone who chose a capped policy, that matters. A $250,000 benefit pool stretches further when providers are billing 190% of Medicare than it would at pre-reform prices, but treatment at a trauma center billing 230% of Medicare will still burn through the cap much faster than the same care at a standard facility.

Late Payments Accrue 12% Interest

If an insurer stalls, MCL 500.3142 puts a price on the delay. Personal protection benefits become overdue if the insurer does not pay within 30 days after receiving reasonable proof of the loss, and overdue amounts accrue simple interest at 12% per year.⁶ There is a longer window for medical bills specifically: if a provider does not submit the bill within 90 days after providing treatment, the insurer gets an extra 60 days on top of the standard 30 before the payment counts as overdue. Collecting the interest sometimes takes a formal complaint or a lawsuit, but the rate is meant to make delay expensive.

1
Michigan Legislature. Michigan Compiled Laws 500.3157 – Charges for Treatment or Training for Injured Persons
2
Centers for Medicare & Medicaid Services. Calendar Year (CY) 2026 Medicare Physician Fee Schedule Final Rule (CMS-1832-F)
3
Michigan Administrative Rules. Michigan Administrative Rules – Insurance No-Fault Fee Schedule
4
Department of Insurance and Financial Services. Bulletin 2019-22-INS – Attendant Care Hourly Limitations
5
State of Michigan. Frequently Asked Questions – Auto Insurance
6
Michigan Legislature. Michigan Compiled Laws 500.3142