Coverage and Reimbursement Fee Schedule Download

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 billed 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.).


Download by Plan Type:

These files do not contain provider specific information that is available in the lookup tool found at http://health.utah.gov/medicaid/stplan/lookup/CoverageLookup.php. To download provider specific files please use the links provided in the "Provider Specific Downloads" section below.

Select the applicable plan type and click download to generate a comma separated (csv) file for download.





* 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 appropriate Plan Type, Provider Type and Date of Service and click on the download button below to generate a comma separated (csv) file for download.







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



Provider Pricing File ONLY:

To download a comma separated (csv) file containing a list of the Procedure Codes, Provider Types, and Charge Factors for ALL provider specific pricing click the button below.



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