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:

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

FFS UPL Payments Made to Private Facilities

• OP Payments

FFS UPL Demonstrations

• SFY 2021 OP UPL Demonstration