Bureau of Coverage and Reimbursement Policy

    Fee Schedule
      Starting 1/1/2012 Utah Medicaid is no longer posting the fee schedule in a spreadsheet format. Please search for the code using the new Fee Schedule Lookup Tool.
      Current Dental Terminology, fourth edition (CDT) (including procedure codes, definitions (descriptors) and other data) is copyrighted by the American Dental Association. © 2008 American Dental Association. All rights reserved. Applicable FARS/DFARS Apply.
    Utah Medicaid Anesthesia Fee Schedule
      Use this information to determine the applicable fee for anesthesia codes billed to Utah Medicaid based on anesthesia base units. To determine the anesthesia base units for any given code please use the Fee Schedule Lookup Tool.
      Use the formula below to calculate the total reimbursment amount for anesthesia codes billed to Utah Medicaid.
      Use the table below to determine the conversion factor for the applicable date of service.
        DateFactor
        7/1/2015$23.73
        7/1/2013$18.27
        7/1/2012$18.27
        5/25/2009$17.92
        10/1/2008$17.98
        7/1/2008$18.34
        10/1/2007$17.98
        7/1/2007$17.38
        7/1/2006$17.04
        7/1/2005$16.72
        7/1/2004$15.94
        10/1/2002$15.79
        7/1/2001$15.33
        5/1/1995$14.29