Utah Medicaid reimbursement rates
44,888 current fee-for-service and managed-care rates from Utah Medicaid, across 120 services and 12 programs, normalized by code, provider level and unit. Each links to one of 142 official source documents.
Last retrieved 2026-10-05. History back to 1985-07-01.
- Current rates
- 44,888
- Services
- 120
- Programs
- 12
- Lines with a plan rule
- 5of 21 service lines
By industry
Applied behavior analysis (ABA)Utah rates, labor costs and changesBehavioral healthUtah rates, labor costs and changesHome healthUtah rates, labor costs and changesHome care & personal careUtah rates, labor costs and changesPrivate duty nursingUtah rates, labor costs and changesSkilled nursing facilitiesUtah rates, labor costs and changesHospiceUtah rates, labor costs and changesIntellectual & developmental disabilitiesUtah rates, labor costs and changesOutpatient therapy (PT, OT, speech)Utah rates, labor costs and changes
Utah rates by service
The median current rate for each service, like-for-like by unit. Follow a service to compare it with every other state.
| Service | Line | Median rate | Unit | Per hour | Variants |
|---|---|---|---|---|---|
| ABA assessment by a behavior analyst | ABA / autism services | $37.51 | 15 min | $150.04 | 3 |
| ABA parent and caregiver training | ABA / autism services | $18.80 | 15 min | $75.18 | 12 |
| ABA therapy with plan changes by an analyst | ABA / autism services | $39.76 | 15 min | $159.04 | 2 |
| Behavior analysis services (disability system) | ABA / autism services | $11.79 | 15 min | $47.16 | 2 |
| Group ABA therapy led by a technician | ABA / autism services | $14.75 | 15 min | $58.98 | 2 |
| One-on-one ABA therapy by a technician | ABA / autism services | $19.67 | 15 min | $78.68 | 3 |
| Behavioral health services (fee schedule) | Behavioral health | $122.69 | 15 min | $33.54 | 33 |
| Community-based wraparound services | Behavioral health | $6.35 | 15 min | $25.40 | 4 |
| Mental health assessment (non-physician) | Behavioral health | $266.54 | — | $66.64 | 18 |
| Mental health counseling | Behavioral health | $75.00 | — | — | 4 |
| Mental health service plan development | Behavioral health | $37.51 | — | — | 1 |
| Outpatient psychotherapy and diagnostic evaluation | Behavioral health | $80.29 | — | $159.90 | 48 |
| Skills training and development | Behavioral health | $18.59 | 15 min | $78.68 | 5 |
| Therapeutic behavioral services | Behavioral health | $25.99 | 15 min | $103.96 | 6 |
| FQHC / RHC visit (PPS or APM rate) | Clinics (FQHC/RHC) | $20.88 | — | — | 1 |
| Dental services | Dental | $130.39 | — | — | 816 |
| Durable medical equipment | Equipment & supplies | $157.44 | — | $51.24 | 442 |
| Enteral and parenteral nutrition | Equipment & supplies | $5.85 | day | — | 47 |
| Medical supplies | Equipment & supplies | $12.14 | — | — | 515 |
| Orthotics and prosthetics | Equipment & supplies | $386.71 | — | $133.48 | 899 |
| Adult day services | Other home & community services | $57.09 | 15 min | $31.84 | 4 |
| Adult foster care | Other home & community services | $378.92 | day | — | 4 |
| Assisted living / alternative living services | Other home & community services | $472.78 | day | — | 5 |
| Case management / support coordination | Other home & community services | $20.18 | 15 min | $37.08 | 29 |
| Chore services (heavy cleaning, yard work, pest control) | Other home & community services | $6.99 | 15 min | $22.36 | 4 |
| Community transition (moving out of an institution) | Other home & community services | $1,500.00 | — | — | 12 |
| Emergency response system installation | Other home & community services | $50.00 | — | — | 22 |
| Emergency response system monitoring | Other home & community services | $38.00 | month | — | 32 |
| Family and peer mentoring | Other home & community services | $16.68 | 15 min | $66.72 | 2 |
| Family caregiver training and support | Other home & community services | $6.16 | 15 min | $22.56 | 3 |
| Financial management services (self-direction) | Other home & community services | $98.43 | 15 min | $293.82 | 10 |
| HCBS cost cap or rate limit | Other home & community services | $49,604.60 | year | — | 2 |
| HCBS waiver service (other) | Other home & community services | $49.00 | day | $37.24 | 73 |
| Home modifications (accessibility) | Other home & community services | $50,000.00 | — | — | 9 |
| Home-delivered meals | Other home & community services | $12.85 | meal | — | 5 |
| Interpreter services | Other home & community services | $9.25 | 15 min | $37.00 | 2 |
| Money management support | Other home & community services | $18.59 | S | — | 2 |
| Nursing assessment | Other home & community services | $312.15 | — | — | 9 |
| Other waiver goods and services | Other home & community services | $2,000.00 | month | — | 4 |
| Respite care (daily) | Other home & community services | $139.27 | day | — | 13 |
| Respite care (hourly) | Other home & community services | $6.72 | 15 min | $23.24 | 33 |
| Respite in a facility (daily) | Other home & community services | $153.00 | day | — | 8 |
| Self-direction coaching / supports broker | Other home & community services | $8.08 | 15 min | $32.32 | 3 |
| Service planning meeting | Other home & community services | $22.52 | — | — | 4 |
| Specialized medical equipment and supplies | Other home & community services | $7,499.50 | — | — | 24 |
| Supportive housing and housing transition supports | Other home & community services | $567.00 | month | — | 1 |
| Vehicle modifications | Other home & community services | $10,000.00 | — | — | 9 |
| Home health agency daily rate / overhead | Home health | $254.63 | day | — | 6 |
| Home health aide visit | Home health | $124.35 | visit | $85.46 | 10 |
| Home health nurse visit (RN or LPN) | Home health | $178.43 | 15 min | $451.04 | 26 |
| Home health occupational therapy | Home health | $446.34 | day | — | 7 |
| Home health physical therapy | Home health | $151.30 | 15 min | $238.96 | 13 |
| Home health speech therapy | Home health | $151.30 | 15 min | $212.04 | 14 |
| Home health visit (other or unspecified) | Home health | $187.88 | 15 min | $315.78 | 125 |
| Hospice continuous home care (hourly) | Hospice | $69.60 | hour | $69.60 | 6 |
| Hospice end-of-life visit add-on (per hour) | Hospice | $17.40 | 15 min | $69.60 | 6 |
| Hospice general inpatient care (daily) | Hospice | $1,197.58 | day | — | 6 |
| Hospice inpatient respite (daily) | Hospice | $559.45 | day | — | 6 |
| Hospice routine home care (daily) | Hospice | $203.17 | day | — | 12 |
| Hospice wage index (area factor) | Hospice | $0.9566 | Labor Adjustment Factor | — | 6 |
| Inpatient DRG pricing input (outlier, cost ratio, stay) | Hospital inpatient | $4.52 | ALOS | — | 840 |
| Inpatient DRG relative weight | Hospital inpatient | $1.48 | weight | — | 798 |
| Inpatient hospital stay (DRG base rate) | Hospital inpatient | $47.12 | Budget Adj | — | 4 |
| Outpatient hospital payment method | Hospital outpatient | $101.00 | % of costs | — | 1 |
| Outpatient hospital services (fee schedule) | Hospital outpatient | $1,074.29 | — | — | 3 |
| Outpatient payment adjustment factor | Hospital outpatient | $0.8259 | Final Factor | — | 1 |
| Surgery center facility fee (per procedure) | Hospital outpatient | $526.99 | — | — | 165 |
| Day habilitation / day program (IDD) | IDD services | $182.47 | day | $55.00 | 9 |
| ICF/IID quality incentive amount per certified bed | IDD services | $5,227.11 | Medicaid certified bed | — | 1 |
| ICF/IID stay (daily rate) | IDD services | $268.03 | New Rate (+ Prop) | — | 7 |
| ICF/IID supplemental daily payment | IDD services | $35.31 | Add-on Rate (Parameter) | — | 2 |
| In-home and community living supports (IDD) | IDD services | $9.86 | — | $33.60 | 19 |
| Job development and self-employment outcome payments | IDD services | $620.00 | 15 min | $69.24 | 6 |
| Prevocational services | IDD services | $15.17 | day | $41.00 | 7 |
| Remote supports (technology-based supervision) | IDD services | $2,000.00 | N | — | 1 |
| Residential habilitation / group home supports | IDD services | $378.19 | day | — | 6 |
| Supported employment (job coaching) | IDD services | $17.31 | day | $62.26 | 11 |
| Supported employment follow-along | IDD services | $1.86 | 15 min | $7.44 | 5 |
| Clinical lab tests | Lab & pathology | $19.38 | — | — | 2847 |
| Nursing facility case-mix (PDPM nursing component) weight | Nursing facility | $1.00 | Case Mix Normal | — | 84 |
| Nursing home daily add-on (ventilator, trach, insurance) | Nursing facility | $185.95 | Add-on Rate (Parameter) | — | 5 |
| Nursing home daily rate component (facility-specific) | Nursing facility | $65.27 | Total FRV Property | — | 168 |
| Nursing home payment method parameter | Nursing facility | $65.00 | per licensed bed | — | 7 |
| Nursing home quality incentive amount per certified bed | Nursing facility | $643.39 | Medicaid certified bed | — | 1 |
| Nursing home statewide price component | Nursing facility | $111.09 | Case Mix Base $ (Base RUG) | — | 1 |
| Nursing home stay (daily rate) | Nursing facility | $248.23 | Case Mix + Property + Flat Rate | — | 85 |
| Swing-bed stay (hospital bed used for nursing-home care) | Nursing facility | $239.73 | Charge Factor | — | 22 |
| Companion care | Personal care & attendant | $12.38 | 15 min | $38.40 | 21 |
| Family caregiver stipend | Personal care & attendant | $6.65 | 15 min | $26.58 | 8 |
| Home health aide or nurse aide care (hourly) | Personal care & attendant | $129.74 | hour | $129.74 | 6 |
| Homemaker / housekeeping help | Personal care & attendant | $9.00 | 15 min | $36.00 | 23 |
| Personal care (daily rate) | Personal care & attendant | $185.06 | day | — | 14 |
| Personal care / attendant care (hourly) | Personal care & attendant | $9.30 | 15 min | $37.20 | 31 |
| Physician-administered drugs (J-codes) | Pharmacy | $17.92 | — | — | 4580 |
| Nurse shadowing / home care training | Private duty nursing | $13.88 | 15 min | $55.52 | 17 |
| Private duty nursing (hourly shifts) | Private duty nursing | $221.55 | hour | $306.41 | 19 |
| Waiver nursing (RN or LPN, by the 15 minutes) | Private duty nursing | $90.90 | 15 min | $363.60 | 27 |
| Physician and practitioner services (fee schedule) | Physician & professional | $447.90 | base unit | $103.80 | 25973 |
| Imaging and radiology | Radiology | $65.73 | — | — | 5171 |
| Activity therapy | Therapy (PT/OT/speech) | $28.55 | 15 min | $114.20 | 1 |
| Nutrition counseling (dietitian) | Therapy (PT/OT/speech) | $24.11 | — | $109.86 | 7 |
| Occupational therapy | Therapy (PT/OT/speech) | $48.07 | 15 min | $181.90 | 6 |
| Occupational therapy evaluation | Therapy (PT/OT/speech) | $98.00 | — | — | 12 |
| Orthotic and prosthetic fitting and training | Therapy (PT/OT/speech) | $36.25 | 15 min | $145.00 | 6 |
| Physical therapy | Therapy (PT/OT/speech) | $30.01 | 15 min | $120.04 | 4 |
| Physical therapy evaluation | Therapy (PT/OT/speech) | $95.48 | — | — | 12 |
| Speech-generating device evaluation | Therapy (PT/OT/speech) | $104.27 | — | — | 3 |
| Speech-generating device therapy | Therapy (PT/OT/speech) | $87.37 | — | — | 3 |
| Speech-language evaluation | Therapy (PT/OT/speech) | $131.89 | — | — | 16 |
| Speech-language therapy | Therapy (PT/OT/speech) | $65.22 | — | — | 3 |
| Swallowing and feeding evaluation | Therapy (PT/OT/speech) | $72.40 | — | — | 3 |
| Swallowing and feeding therapy | Therapy (PT/OT/speech) | $71.92 | — | — | 3 |
| Air ambulance transport | Transportation | $5,431.35 | — | — | 2 |
| Ambulance mileage | Transportation | $21.12 | mile | — | 3 |
| Ground ambulance transport | Transportation | $39.44 | — | — | 4 |
| Non-emergency medical transportation (NEMT) | Transportation | $16.00 | — | — | 34 |
| Staff mileage add-on | Transportation | $1.09 | mile | — | 3 |
| Waiver transportation (to community activities) | Transportation | $20.97 | day | — | 26 |
| Eyeglasses and contact lenses | Vision & hearing | $68.50 | — | — | 190 |
| Hearing aids and hearing services | Vision & hearing | $672.00 | — | — | 117 |
Most-compared billing codes in Utah
Where Utah ranks among states for codes published widely. Rank 1 = highest rate.
| Code | Service | Utah | All-state median | Rank |
|---|---|---|---|---|
| 10005 | Physician and practitioner services (fee schedule) | $99.65 | $88.19 | 21 of 50 |
| 10006 | Physician and practitioner services (fee schedule) | $45.78 | $46.23 | 26 of 50 |
| 10007 | Physician and practitioner services (fee schedule) | $256.57 | $203.95 | 18 of 50 |
| 10008 | Physician and practitioner services (fee schedule) | $105.90 | $95.09 | 23 of 50 |
| 10009 | Physician and practitioner services (fee schedule) | $307.59 | $276.55 | 24 of 50 |
| 10010 | Physician and practitioner services (fee schedule) | $175.81 | $157.44 | 23 of 50 |
| 10021 | Physician and practitioner services (fee schedule) | $84.95 | $73.91 | 15 of 50 |
| 10030 | Physician and practitioner services (fee schedule) | $517.44 | $401.12 | 16 of 50 |
| 10060 | Physician and practitioner services (fee schedule) | $96.62 | $88.74 | 22 of 50 |
| 10061 | Physician and practitioner services (fee schedule) | $185.72 | $153.30 | 13 of 50 |
| 10080 | Physician and practitioner services (fee schedule) | $200.55 | $129.47 | 16 of 50 |
| 10081 | Physician and practitioner services (fee schedule) | $283.78 | $200.51 | 16 of 50 |
| 10120 | Physician and practitioner services (fee schedule) | $117.80 | $98.41 | 18 of 50 |
| 10121 | Physician and practitioner services (fee schedule) | $231.69 | $171.22 | 10 of 50 |
| 10140 | Physician and practitioner services (fee schedule) | $130.84 | $109.79 | 17 of 50 |
| 10160 | Physician and practitioner services (fee schedule) | $110.71 | $86.10 | 11 of 50 |
| 10180 | Physician and practitioner services (fee schedule) | $241.55 | $182.52 | 11 of 50 |
| 11000 | Physician and practitioner services (fee schedule) | $44.50 | $38.05 | 19 of 50 |
| 11001 | Physician and practitioner services (fee schedule) | $22.84 | $18.34 | 14 of 50 |
| 11004 | Physician and practitioner services (fee schedule) | $433.04 | $437.24 | 29 of 50 |
| 11005 | Physician and practitioner services (fee schedule) | $592.70 | $594.32 | 27 of 50 |
| 11006 | Physician and practitioner services (fee schedule) | $534.67 | $545.22 | 29 of 50 |
| 11008 | Physician and practitioner services (fee schedule) | $209.12 | $211.94 | 27 of 50 |
| 11010 | Physician and practitioner services (fee schedule) | $394.12 | $286.71 | 12 of 50 |
| 11011 | Physician and practitioner services (fee schedule) | $451.74 | $326.17 | 11 of 50 |
| 11012 | Physician and practitioner services (fee schedule) | $577.71 | $442.71 | 11 of 50 |
| 11042 | Physician and practitioner services (fee schedule) | $111.15 | $84.55 | 12 of 50 |
| 11043 | Physician and practitioner services (fee schedule) | $202.04 | $167.89 | 12 of 50 |
| 11044 | Physician and practitioner services (fee schedule) | $242.19 | $227.02 | 22 of 50 |
| 11055 | Physician and practitioner services (fee schedule) | $52.26 | $40.24 | 18 of 50 |
| 11056 | Physician and practitioner services (fee schedule) | $60.62 | $47.35 | 17 of 50 |
| 11057 | Physician and practitioner services (fee schedule) | $66.50 | $52.53 | 18 of 50 |
| 11102 | Physician and practitioner services (fee schedule) | $71.43 | $71.28 | 25 of 50 |
| 11103 | Physician and practitioner services (fee schedule) | $36.52 | $36.83 | 26 of 50 |
| 11104 | Physician and practitioner services (fee schedule) | $90.64 | $84.93 | 24 of 50 |
| 11105 | Physician and practitioner services (fee schedule) | $45.22 | $42.80 | 23 of 50 |
| 11106 | Physician and practitioner services (fee schedule) | $113.06 | $101.36 | 22 of 50 |
| 11107 | Physician and practitioner services (fee schedule) | $53.02 | $50.82 | 24 of 50 |
| 11300 | Physician and practitioner services (fee schedule) | $72.09 | $55.51 | 20 of 50 |
| 11301 | Physician and practitioner services (fee schedule) | $87.07 | $67.43 | 20 of 50 |
Managed care in Utah
27 plans on record, 0 state-directed payment records, 1,235 published capitation cells.
Who sets the rate, line by line →Recent rate changes and notices
| Notice | Status | Effective |
|---|---|---|
| MIB September 2026 26-88 New Community Engagement Requirements for Hospital Presumptive | effective | 2027-01-01 |
| MIB September 2026 26-90 Changes to Reporting of Maternity Care | effective | 2027-01-01 |
| MIB September 2026 26-96 Behavioral Health Revenue Code Updates | effective | 2027-01-01 |
| MIB September 2026 26-89 Telehealth Modifiers Update | effective | 2026-09-01 |
| MIB September 2026 26-92 Upper Payment Limit (UPL) Project | effective | 2026-09-01 |
| MIB September 2026 26-93 Policy Clarification for Inpatient Medical Detoxification for Substance Use | effective | 2026-09-01 |
| MIB September 2026 26-95 Behavioral Health Code Standardization | effective | 2026-09-01 |
| MIB July 2026 26-63 Cache County Reclassification to Urban Status | effective | 2026-07-01 |
| MIB July 2026 26-65 Billing Guidance | effective | 2026-07-01 |
| MIB July 2026 26-66 Telehealth Modifiers | effective | 2026-07-01 |
| MIB July 2026 26-67 Dental Services for Pregnant, Postpartum, and EPSDT Members | effective | 2026-07-01 |
| MIB July 2026 26-70 Quantity Limit Updates | effective | 2026-07-01 |
Frequently asked questions
Where does Utah publish its Medicaid fee schedules?
Utah publishes rates across 142 official documents (fee schedules, rate notices and bulletins). Every rate on this page links to its source document.
How many Medicaid rates does Utah publish?
44,888 rates are current across 120 services and 12 programs, with 263,519 versions on record since 1985-07-01.
Do Utah Medicaid managed-care plans pay the fee schedule?
For 5 of 21 service lines, plan contracts or state law set a rule plans must follow (a floor, a state-set rate or a required pass-through). For the rest, plans negotiate. See the managed-care page for each line's rule and citation.
Other states
AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
Your Utah rate cardYour codes, what Utah pays, what plans must pay, and every change in 2026.