Outpatient Hospital Resources

The Medicaid Outpatient Fee Schedule Report is no longer being generated. The payment of claims will still follow the process outlined in the Utah Medicaid State Plan, which may be found here. opens in a new tab

Medicaid coverage may be found on the Coverage and Reimbursement Code Lookup tool. Additionally, reimbursement for services not priced using OPPS or CAH methodology is based on the established Medicaid fee schedule found at:
https://health.utah.gov/stplan/lookup/CoverageLookup.php opens in a new tab

Medicare Outpatient Code Editor, OPPS Pricer, fee schedules and other information may be found on CMS’s website at:
https://www.cms.gov/ opens in a new tab

Effective 10/1/2020, a factor will be applied to OPPS claims to offset annual Medicare inflation changes. The factor is listed below:

Start Date

Inflation

Factor

1/1/2024

3.10%

0.8720

1/1/2023

3.80%

0.8990

1/1/2022

2.00%

0.9332

1/1/2021

2.40%

0.9518

10/1/2020

2.60%

0.9747

Outpatient Upper Payment Limit (UPL) Fee for Service (FFS)

FFS UPL Payments Made to Private Facilities

FFS UPL Demonstrations

    Contact Information

    General Information

    Via U.S. Post Office

    Via UPS or FedEx

    DHHS, Division of Integrated Healthcare

    ORCA/Reimbursement

    PO Box 143325

    Salt Lake City, UT  84114-3325

    DHHS, Division of Integrated Healthcare

    ORCA/Reimbursement

    288 North 1460 West

    Salt Lake City, UT  84116-3231