MedicaidPrior AuthHigh impact
September 2022 Medicaid Information Bulletin
Utah Medicaid·UT · General Surgery, Pediatrics, Palliative Care·Government Programs
Effective date
Sep 1, 2022
We identified it
Jun 21, 2026
Summary
Utah Medicaid has updated Multiple Procedure Payment Reduction (MPPR) policies for surgical procedures, removed prior authorization requirements for personal care services (T1019) and enteral formula products for EPSDT-eligible children, increased Private Duty Nursing maximum hours, and expanded hospice care to allow physician assistants and nurse practitioners as attending physicians.
Action Required
Effective September 1, 2022: Billing team must update system to apply Multiple Procedure Payment Reduction (100% primary procedure, 50% secondary, 25% subsequent) when billing multiple procedures on same date. Stop requiring prior authorization for personal care services code T1019 and enteral formula codes B4149-B4162 for EPSDT patients. Update Private Duty Nursing billing to reflect new maximum hours (9-15 hours based on acuity grid). Configure hospice billing to accept physician assistants and nurse practitioners as attending physicians. Claims may be incorrectly processed without these updates.