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November 2026 Medicaid Information Bulletin
Effective date
Nov 1, 2026
Identified
Nov 3, 2026
Summary
This is the Utah Medicaid November 2026 bulletin, which bundles 15 changes. Several took effect November 1, 2026 (dental fluoride dispensing and topical fluoride, periodontal maintenance prior authorization removed, and flu vaccine routing), while most behavioral health, maternity and electronic prior authorization changes take effect January 1, 2027, with subacute crisis enrollment opening December 17, 2026. Because the bulletin was issued in November 2026 and the November 1 changes have already taken effect, confirm current applicability in the Utah Medicaid PRISM code lookup tool before billing.
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What to do
Action · 18 steps
01The bulletin states that unless otherwise noted, changes take effect November 1, 2026.
02Several are already effective as of the analysis date, and the rest are future dates.
03Check current applicability in the PRISM Coverage and Reimbursement Code Lookup Tool before acting.
04Already effective November 1, 2026: Dentists and oral surgeons who dispense prescription fluoride to members aged 6 months to 17 years should bill D9630 for dispensing only, and only when the fluoride is pre-packaged, dispensed as supplied, and dispensed from the practice where they regularly practice.
05Dental billing: D1208 (topical fluoride, excluding varnish) is open for members aged 6 months to 17 years, limited to four applications per calendar year combined with D1206 varnish.
06Dental billing: periodontal maintenance (D4910) no longer needs prior authorization; it is covered only after scaling and root planing (D4341 or D4342), once every six months, not on the same date as SRP, and not within six months of a prophylaxis.
07Front desk and billing: adults 19 and older may get flu vaccine billed through pharmacy point of sale; members 18 and younger must get flu vaccine through the Vaccines for Children program.
08Before January 1, 2027: Billing team, by December 17, 2026, if the practice plans to offer the subacute crisis mental health residential service, enroll the facility in PRISM as an FAO with a dedicated NPI, using PAC 181 and the listed provider type; the service requires prior authorization and a $683 per diem, and claims go on the 837I with revenue code 0911 plus H0017 (IMD facility, ages 21-64) or H2013 (non-IMD), limited to 60 days per episode.
09Billing team, starting January 1, 2027: report all Targeted Case Management for Individuals with Serious Mental Illness only under T1017, and stop using H0006, which the bulletin says will be closed.
10Billing team, in PRISM and charge entry for the psychotherapy codes 90791, 90792, 90846, 90847, 90849 and 90853: submit each encounter as one unit per day, with the minimum times stated in the bulletin (16, 16, 26, 26, 50-60 and 45-60 minutes).
11Billing team for residential, partial hospitalization and intensive outpatient services: from January 1, 2027, bill one unit per day on the 837I, with the listed revenue code paired with its HCPCS code (1001 with H0017 or H2013; 1002 with H0018 or H2036; 0912 with H0035; 0913 with H0037; 0905 with S9480; 0906 with H0015).
12Maternity billing (January 1, 2027): global maternity CPT codes are deleted for antepartum and postpartum care and replaced with per-encounter E/M codes with modifier TH; labor management and delivery are reported with new 2027 codes.
13Bill global maternity codes if delivery is before January 1, 2027, even if the expected delivery was in 2027; if delivery is on or after January 1, 2027, bill unbundled services.
14Adjust any previously submitted unbundled maternity claims where the delivery was in 2026.
15Refer to the AMA Antepartum Transition Reporting PDF and the bulletin's Women's Services manual.
16Electronic prior authorization: Utah's ePA go-live is January 1, 2027; sandbox testing is open now through the DHHS invitation, and providers can register through the Utah Medicaid interoperability page.
17Hospital presumptive eligibility adult expansion: from January 1, 2027, applicants must attest to community engagement exclusion, exception or compliance (80 hours), and eligibility staff should watch for the trainings and the hpepolicy@utah.gov contact.
18Questions on behavioral health per diem and units: dmhfmedicalpolicy@utah.gov.
Codes mentioned
D9630D1208D1206D4341D4342D4910T1017H0006H0017H2013H0018H2036H0035H0037S9480H0015907919079290846908479084990853
Original notice
November 2026 Medicaid Information Bulletin
medicaid-documents.dhhs.utah.gov · Always check the source before changing claims.
Related changes
See all Utah Medicaid changes →September 2026 Medicaid Information BulletinHighEffective Jan 1, 2027 · 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 changesDentistryOral & Maxillofacial SurgeryPsychiatryPediatricsOB-GYNFamily MedicinePharmacyCode D9630Code D1208Code D1206Code D4341Code D4342Code D4910Code T1017Code H0006Code H0017Code H2013Code H0018Code H2036Code H0035Code H0037Code S9480Code H0015Code 90791Code 90792Code 90846Code 90847Code 90849Code 90853