Provider Newsletter
Reimbursement Policy Updates – November Newsletter 2026
Provider Newsletter
Reimbursement Policy Updates – November Newsletter 2026
Health Choice Utah uses reimbursement policies as guidelines for payment determinations in accordance with the member's benefits. Quarterly notice of recently approved, revised, and archived reimbursement policies is provided in the Provider Newsletter for your convenience. Reimbursement policy updates are provided for informational purposes only. Coverage and reimbursement are subject to applicable member benefits, provider contracts, and policy requirements and should not be assumed based on the information summarized here.
| NEW POLICIES | ||||
|---|---|---|---|---|
| Policy Number | Policy Name | Effective Date | Summary | |
| REIMB-048 (New) | Allergen Immunotherapy (AIT) | 09/25/2026 | Health Choice Utah requires CPT 95165 to be billed based on the actual number of allergen immunotherapy doses anticipated when the allergen extract is prepared. Reimbursement is limited to 150 units per member per rolling 365-day period, and documentation supporting billed units must be maintained and provided upon request. Please see the policy for complete billing requirements, limitations, and documentation guidelines. | |
| REVISED POLICIES | ||||
|---|---|---|---|---|
| Policy Number | Policy Name | Effective Date | Summary | |
| REIMB-042 (Revised) | Doula Services | 09/23/2026 | Health Choice Utah provides coverage for doula labor support services in approved settings, such as hospitals and birthing centers, to support maternal health outcomes and birthing individuals. Coverage and reimbursement for doula services are subject to prior authorization and approved provider requirements. Members should refer to their Specific Plan Determination (SPD) for benefit coverage. Please see the policy for complete coverage criteria, limitations, and reimbursement details. | |
| ARCHIVED POLICIES | ||
|---|---|---|
| Policy Number | Policy Name | Effective Date |
| REIMB-003 (Archived) | Status B Bundled Codes | 10/15/2026 |
| REIMB-012 (Archived) | Sources for Coding Determinations | 10/15/2026 |
| REIMB-025 (Archived) | OB Anesthesia | 10/15/2026 |