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.

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

The “emergency” designation is based on the principal diagnosis (ICD-9/ICD-10 Codes) being on the list downloaded for a selected date of service.

Note: This is not a list of diagnoses payable under the Emergency Services Program for Non-Citizens. For information relating to that program, please refer to the Emergency Services Program for Non-Citizens subsection of the Section I (All Providers) provider manual.

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Utah Medicaid Table of Authorized Emergency Department Diagnoses:

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

Select Plan Type: Traditional Non-Traditional Primary Care Network

Date of Service:   (MM/DD/YYYY)

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

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Utah Medicaid Table of Authorized Emergency Inpatient Diagnoses:

Inpatient hospital services do not require a co-payment if the primary diagnosis is listed in the download for the selected plan type and date of service.

Select Plan Type: Traditional Non-Traditional

Date of Service:   (MM/DD/YYYY)

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