MedicaidPrior AuthHigh impact
January 2026 Medicaid Information Bulletin
Utah Medicaid·UT · Dentistry, Oral & Maxillofacial Surgery, Chiropractic +4 more·Government Programs
Effective date
Jan 1, 2026
We identified it
Jun 21, 2026
Summary
Utah Medicaid issued a comprehensive bulletin with 22 policy changes effective January 1, 2026, including new orthodontic prior authorization requirements using IOTN forms, updated CLIA modifier requirements, expanded chiropractic coverage criteria, and removal of referral requirements for physical/occupational therapy. Multiple provider manuals were updated and some services were consolidated or archived.
Action Required
By January 1, 2026: Billing teams must implement multiple changes - (1) For orthodontic providers: Use new Utah Medicaid IOTN forms for all prior authorization requests instead of Salzmann Evaluation Index, download forms from Utah Medicaid Forms webpage; (2) For laboratories with Certificate of Waiver only: Continue using QW modifier for CLIA waived tests, all other CLIA levels stop using QW modifier after February 12, 2026; (3) Update chiropractic billing to verify patient eligibility (ages 6-20 or pregnant members only), limit to 12 visits per rolling year with prior auth required for additional visits; (4) Remove referral requirements for physical therapy and occupational therapy services, update to 20 sessions per discipline per calendar year limit. Failure to use IOTN forms will result in orthodontic prior auth denials.