BULLETIN 99-1

In 1989 the Insurance Department was mandated by the Utah Legislature in 31A-22-307(2), to "prepare and publish a relative value study which sets forth the unit value and the 75th percentile charge assigned to each type of service and accommodation." The code also requires that the relative value study be "updated every other year." The first P.I.P. relative value study was published August 1, 1990.

It has come to the attention of The Insurance Department that some insurers are not paying bills directed to them by providers using the physicians current procedural terminology, or CPT codes and their modifiers based on the Department's current relative value study. Instead, they are requiring the provider to use codes that have been created or revised since the relative value study was last updated.

Section 31A-22-307 was written to regulate the payment of personal injury protection claims by auto insurers. The relative value is prepared and published to set a standard for payment of these claims and is updated every other year to implement the changes that occur during the two year interval. Auto insurers licensed to do business in Utah are required to use the Department's current P.I.P. Relative Value Study for payment due. CPT codes created or changed subsequent to the current revision of the Department's relative value study, are not to be used.

DATED this 22nd Day of March, 1999.

Insurance Commissioner

[Back to Top]