With the implementation of the Provider Reimbursement Information System for Medicaid (PRISM), the legacy Coverage and Reimbursement Code Lookup will no longer be an up-to-date resource for verifying code-specific policies. This tool will remain active, but will only be functional for payment dates on or before March 10, 2023.
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.).
The prior authorization requirements listed in this tool are applicable for services requested and billed directly to Utah Medicaid.
All Individuals eligible under Targeted Adult Medicaid are eligible for Traditional Medicaid. Individuals eligible under Adult Expansion Medicaid are eligible for the following: Adults with a dependent child living in the home will receive Non-Traditional Medicaid; Adults without a dependent child living in the home will receive Traditional Medicaid.
All individuals eligible for Primary Care Network (PCN) are transitioned to Adult Expansion Medicaid effective 4/1/2019. Information regarding the PCN program will be available for reference until 4/1/2020.
If you would like to view the entire fee schedule, rather than searching for a particular code, please use our Fee Schedule Download Tool.
If you would like to view the entire diagnosis schedule, please use our Diagnosis Schedule Download Tool.