Provider Connection
Reimbursement Policy Updates – November Newsletter 2025
Provider Connection
Reimbursement Policy Updates – November Newsletter 2025
University of Utah Health Plans uses medical policies as guidelines for coverage determinations in accordance with the member’s benefits. Quarterly notice of recently approved and revised medical policies is provided in Provider Connection for your convenience. The Medical Policy Updates section of this newsletter does not indicate that coverage is provided for the procedures listed.
| NEW POLICIES | |||
|---|---|---|---|
| Policy Number | Policy Name | Effective Date | Summary |
| REIMB-044 (New) | Routine Supplies and Services | 08/25/2025 | Commercial Plan: This policy outlines details of specific services and supplies that U of U Health Plans considers routine. Please see the policy for further details. |
| REIMB-045 (New) | Medical/Surgical Supplies | 08/25/2025 | Commercial Plan: U of U Health Plans considers certain services and supplies routinely used by patients, within a level of care setting, or in the delivery of medical-surgical services, including all related equipment necessary for that particular acuity level, to be ineligible for separate reimbursement when reported by a facility. Unless provider, state, federal contract and/or requirements indicate otherwise. |
| REIMB-046 (New) | Modifiers | 08/30/2025 | Commercial Plan: U of U Health Plans adjudicates all submitted Current Procedural Terminology (CPT®) and Healthcare Common Procedure Coding System (HCPCS) modifiers in accordance with nationally recognized coding guidelines established by the American Medical Association (AMA) and the Centers for Medicare & Medicaid Services (CMS). Modifiers must be used appropriately to reflect distinct procedural circumstances, clarify services rendered, or indicate billing exceptions as outlined in CPT coding instructions and CMS guidelines. U of U Health Plans reviews modifiers for clinical appropriateness, necessity, and billing accuracy. Improper or unsupported use of modifiers may result in claim denial or adjustment. Providers are expected to maintain documentation supporting the use of all modifiers applied to a claim. U of U Health Plans reserves the right to update or adjust its claims processing policies in alignment with changes to AMA, CMS, or industry standard coding and reimbursement rules. |
| REVISED POLICIES | |||
|---|---|---|---|
| Policy Number | Policy Name | Effective Date | Summary |
| No revised reimbursement policies at this time. | |||
| ARCHIVED POLICIES | |||
|---|---|---|---|
| Policy Number | Policy Name | Effective Date | |
| REIMB-002 (Archived) | Urine Drug Testing in Outpatient Setting | 08/27/2025 | |