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September 2026 Medicaid Information Bulletin
Effective date
Jan 1, 2027
Identified
Sep 10, 2026
Summary
Utah Medicaid's September 2026 bulletin includes several billing changes that begin January 1, 2027, including telehealth modifiers 93 or 95, service-level reporting for maternity care, per diem billing for residential, partial hospitalization and intensive outpatient behavioral health programs, and single-unit billing for several psychotherapy and evaluation codes. Other items already took effect, including the Spravato observation codes and the home health TE modifier change on July 1, 2026, and the nursing facility ancillary changes, which apply retroactively to services on or after July 1, 2026. Unless otherwise noted in the bulletin, changes take effect on September 1, 2026.
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What to do
Action · 12 steps
01Beginning January 1, 2027: Billing team: when providing services via telehealth, append modifier 93 (synchronous telemedicine service rendered via telephone or other real-time interactive audio-only system) or modifier 95 (synchronous telemedicine service rendered via a real-time interactive audio and video system), per the Section I General Information provider manual, Chapter 12-7.3 Modifiers.
02Maternity care reporting moves from global maternity codes to unbundled, service-level reporting, and antepartum visits performed after December 31, 2026 are reported using E/M office visit codes, per the updated CPT Guidelines.
03For residential, partial hospitalization and intensive outpatient behavioral health services, submit claims on the 837I (institutional) transaction with one unit per day and the revenue code with its HCPCS code appended to each revenue code: mental health residential treatment IMD facility 1001 with H0017, non-IMD facility 1001 with H2013; substance use disorder residential treatment IMD facility 1002 with H0018, non-IMD facility 1002 with H2036; partial hospitalization less intensive 0912 with H0035; partial hospitalization intensive 0913 with H0037; intensive outpatient psychiatric 0905 with S9480; intensive outpatient chemical dependency 0906 with H0015.
04In January 2027, PRISM is updated so that codes 90791, 90792, 90846, 90847, 90849 and 90853 are submitted as one whole encounter unit rather than 15-minute units, with the maximum of 1 unit per day.
05Before antepartum visits are reported under this update, note that effective September 1, 2026, pregnant members expected to deliver after December 31, 2026 may be reported with E/M office visit codes for fewer than 4 visits (with modifier TH), with 59425 for 4 to 6 visits and 59426 for 7 or more visits, each billed once per pregnancy per provider group.
06Already effective July 1, 2026: when a licensed practical nurse provides private duty nursing services, report the TE modifier with HCPCS T1000 and T1005; the TE percentage decreased from 78% to 58.15%.
07Already effective July 1, 2026: bill 99415 for the first hour and 99416 for each additional 30 minutes of prolonged observation performed by clinical staff under the direction of a physician or other qualified healthcare professional after Spravato, and discontinue billing 99417 and 99418 for observation performed by clinical staff.
08Already effective July 1, 2026 (retroactive): physical therapy, occupational therapy and speech-language pathology services by clinicians employed by the nursing facility are routine services under the daily per diem rate, while prescription drugs, enteral formula, oxygen, laboratory and radiology remain billable ancillary services.
09Already effective September 1, 2026: for members without a physical health managed care plan, prior authorization is not required for medical detoxification, and for members enrolled in an ACO or UMIC Plan, medical detoxification must be coordinated and obtained directly through the member's health plan.
10Already effective September 1, 2026: for EPSDT members receiving behavioral health services before a formal diagnosis is established, Z55-Z60, Z62-Z65 and Z69-Z73 codes may be used; once a definitive clinical diagnosis is established, the appropriate primary diagnosis code must be used, and documentation must explicitly demonstrate medical necessity for the procedure code billed.
11Starting September 30, 2026 (now past): check whether the practice has registered on the Medicaid interoperability webpage for Utah Medicaid's Prior Authorization Health Data Exchange and Provider Access Health Data Exchange.
12Watch for future Utah Medicaid bulletins, which will provide further details on the nursing facility ancillary changes.
Codes mentioned
907919079290846908479084990853594255942699415994169941799418T1000T1005H0017H2013H0018H2036H0035H0037S9480H0015
Original notice
September 2026 Medicaid Information Bulletin
medicaid-documents.dhhs.utah.gov · Always check the source before changing claims.
Related changes
See all Utah Medicaid changes →November 2026 Medicaid Information BulletinHighEffective Nov 1, 2026 · Government ProgramsJuly 2026 Medicaid Information BulletinHighEffective Jul 1, 2026 · Government ProgramsJanuary 2026 Medicaid Information BulletinHighEffective Jan 1, 2026 · Government ProgramsMarch 2026 Medicaid Information BulletinHighEffective Mar 1, 2026 · Government ProgramsBrowse every Utah Medicaid change in the policy list
Related policy hubs
Utah Medicaid policiesUT policy changesPsychiatryOB-GYNPediatricsPharmacyPhysical TherapyOccupational TherapySpeech TherapyCode 90791Code 90792Code 90846Code 90847Code 90849Code 90853Code 59425Code 59426Code 99415Code 99416Code 99417Code 99418Code T1000Code T1005Code H0017Code H2013Code H0018Code H2036Code H0035Code H0037Code S9480Code H0015