Utah DHHS (Medicaid) · January 26, 2026 · Primary source
January2026-MIB.pdf
Summary
Utah Medicaid's January 2026 Medicaid Information Bulletin implements multiple policy changes effective January 1, 2026. Key items include billing requirements for mental health and SUD treatment, medically managed outpatient detoxification and ambulatory detoxification coverage, behavioral health code standardization, integrated healthcare services provider manual updates, and CLIA modifier changes for waived tests. Additional updates affect dental, orthodontics, physical therapy, occupational therapy, chiropractic, and DME coverage policies. The bulletin also notes a forthcoming PRISM system migration from ForgeRock to Identity Cloud scheduled for April 2026.
What this may mean
Behavioral health and SUD providers billing Utah Medicaid must comply with updated code standardization and billing requirements for mental health and SUD treatment effective January 1, 2026, and the medically managed outpatient detoxification policy establishes new coverage and billing parameters for ambulatory detoxification services. Laboratories with CLIA certification levels above Certificate of Waiver are no longer required to submit the QW modifier for waived tests effective February 12, 2026. Physical and occupational therapy providers no longer require a health service referral for therapy services, aligned with HB0188 enacted March 2025, subject to a 20-session per discipline annual limit.
Informational only. Not legal, medical, financial, or other professional advice. Always consult a qualified professional familiar with your specific facts before relying on any item.
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