The information provided by this lookup tool does not guarantee reimbursement, but is intended to provide coverage and reimbursement information for selected procedure codes as of the "Updated On" date specified in the search results. For additional information regarding specific billing requirements and coverage or rates not managed in this Lookup tool, please consult the Medicaid Provider Manuals or contact us.

This fee schedule does not apply to hospital outpatient services paid under the Outpatient Prospective Payment System (OPPS), Indian Health Services (IHS), School Based Skills Development (SBSD), nor does it apply to Utah's 1915(c) HCBS waivers. Medicaid covered claims adjudicated through OPPS will be paid according to the applicable Medicare fee schedule, IHS providers are generally paid using the All-Inclusive Rate (please refer to the Indian Health provider manual for more specifics) and 1915(c) HCBS waiver providers should refer to the appropriate waiver-specific fee schedule.

For a list of provider types for which coverage and/or rates do not apply (as shown by this lookup tool), please click here.

Generally, the fees represented here are only for fee-for-service claims paid directly by Utah Medicaid using Utah Medicaid's fee schedule. This fee schedule does not account for any enhancement in fee schedule amounts (i.e., rural physician enhancements, rural dental enhancements, etc.).

All Individuals eligible under Targeted Adult Medicaid (effective 11/1/2017) are eligible for Traditional Medicaid. However, Targeted Adult Medicaid individuals ages 19 or 20 are not eligible for EPSDT (CHEC) services. Temporarily, services for individuals age 19 or 20 eligible under Targeted Adult Medicaid are denoted in the Non-Traditional Plan type. Services for Individuals age 21 through 64 eligible under Targeted Adult Medicaid are denoted in the Traditional plan type.


Download by Plan Type:

These files do not contain provider specific information that is available in the lookup tool found at CoverageLookup. To download provider specific files please use the links provided in the "Provider Specific Downloads" section below.

Select the Plan Type and Date of Service, then click the Download button below to generate a comma separated (.csv) file.





* CSV files can be opened using Microsoft Excel or other spreadsheet programs.



Provider Type Specific Downloads:

This download contains provider specific information. If you are looking for general fee schedule information please use the download feature above.

Select the Plan Type, Provider Type and Date of Service, then click the Download button below to generate a comma separated (.csv) file.







* CSV files can be opened using Microsoft Excel or other spreadsheet programs.



Provider Pricing File ONLY:

Select the Date of Service, then click the Download button below to generate a comma separated (csv) file containing a list of the Procedure Codes, Provider Types, and Charge Factors for ALL provider specific pricing.



* CSV files can be opened using Microsoft Excel or other spreadsheet programs.



HCPCS/NDC Crosswalk:

Select the Date of Service, then click the Download button below to generate a comma separated (csv) file containing a list of the HCPCS Codes and NDCs.



* CSV files can be opened using Microsoft Excel or other spreadsheet programs.


Revenue Code Download by Plan Type:

    NOTES:
    • 1. NDC required for Provider Administered Drugs
    • 2. Revenue Code 760 used for Long Term Acute Care (LTAC) only
    • 3. This list does not guarantee coverage

Select the Plan Type and Date of Service, then click the Download button below to generate a comma separated (.csv) file.





* CSV files can be opened using Microsoft Excel or other spreadsheet programs.