September 2026 Medicaid Information Bulletin

REQUIREMENTS: By September 30, 2026: (1) Billing team must register providers for interoperability participation by visiting https://medicaid.utah.gov/interoperability/ and submitting Provider section application for Prior Authorization Health Data Exchange and Provider Access Health Data Exchange. (2) By January 1, 2027: Billing team must update billing system to require modifiers 93 or 95 to be appended to all telehealth claims (on encounter forms and in system rules). (3) For maternity cases with expected delivery after December 31, 2026: Effective September 1, 2026, billing team must transition to reporting antepartum visits using E/M codes (99201-99215) with modifier TH for <4 visits, code 59425 for 4-6 visits, or code 59426 for 7+ visits (billed once per pregnancy per provider group); after December 31, 2026, use only E/M codes per updated CPT guidelines. (4) Effective July 1, 2026 (retroactive): Billing team must update LPN Private Duty Nursing rate calculations—change TE modifier percentage from 78% to 58.15% when billing HCPCS T1000 and T1005. (5) Effective July 1, 2026 (retroactive, published September 2026): Billing team must stop reporting PT, OT, and SLP services as separately billable ancillary services for nursing facilities; these are now included in the daily per diem rate under the Upper Payment Limit (UPL) alignment. (6) October-November 2026: HPE staff must attend mandatory training on new Community Engagement (CE) screening requirements for Adult Expansion (AE) population (effective January 1, 2027); sign up link: https://forms.gle/6MecZZKqNrNWfFCL7. Failure to append required modifiers will result in claim denials. Failure to register for interoperability will prevent participation in prior authorization and data exchange. Failure to transition maternity billing codes will cause claim rejections after December 31, 2026.