MedicaidBilling CodesMedium impact
January 2025 Medicaid Information Bulletin
Utah Medicaid·UT · Dentistry, Oral & Maxillofacial Surgery, Family Medicine +1 more·Government Programs
Effective date
Jan 1, 2025
We identified it
Jun 21, 2026
Summary
Utah Medicaid updated electronic billing requirements in PRISM, added new dental procedure coverage, and implemented multiple code and coverage changes effective January 1, 2025. Key changes include new dental codes for denture preparation, CLIA waived test modifier requirements, and updated vaccine codes.
Action Required
Immediately: Update billing system to include new dental codes D7310, D7311, D7340, D7350, D4910, and D9410 with appropriate coverage limitations. Ensure all CLIA waived tests are billed with QW modifier. Update vaccine codes 90624 and 90684 to covered status. By April 2025: Update provider information in PRISM portal at https://prism.health.utah.gov/. Verify electronic billing files meet new HIPAA 5010 requirements with correct NPI and Provider ID in specified segments.