Utah Medicaid pays $122.78 for code 99213, the most common return office visit. That ranks 4th of 46 states, well above the national median of $75.27 and above the Medicare nonfacility rate of $91.96. Utah is also first in the nation on two home-based services: agency attendant care at $84.84 an hour and registered-nurse private duty nursing at $254.03 an hour.
For most provider types, the Utah Medicaid fee schedule is one of the stronger ones we track. MedicaidRate holds all 44,888 current Utah rates from 142 official source documents across 12 programs, with history back to 1985. Each rate links to its source publication.
Nearly all of Utah's published rates sit in one program: Utah Medicaid fee-for-service under the Traditional plan, with 43,782 rates. The source is the Utah Medicaid Coverage and Reimbursement Lookup (PRISM) fee schedule download, published by provider type. Files on record include the Traditional schedule, PAC 033 Physicians, PAC 140 Physician Assistant, PAC 101 Ambulatory Surgical Center, PAC 027 Podiatry, PAC 035 Home Health Agency, PAC 017 Certified Nurse Midwife and the provider pricing file. Hospital inpatient stays are priced through the Utah Medicaid MS-DRG Payment Calculation (v43a).
Physician and practitioner services are the largest line at 25,973 rates, then radiology (5,171), pharmacy (4,580) and laboratory (2,847).
The other programs are smaller but distinct:
- The Non-Traditional plan, a reduced-benefit fee-for-service plan for some adult expansion members, with 626 rates.
- The Division of Services for People with Disabilities (DSPD) rate schedule, 189 rates under DSPD service codes.
- 1915(c) waivers: Community Supports for intellectual disabilities and related conditions (56), Community Transitions (50), Aging for individuals 65 or older (46), New Choices (45), Acquired Brain Injury (44), Limited Supports (25), Physical Disabilities (10), Technology Dependent and Medically Complex Children's.
The Non-Traditional plan matters for clinics serving expansion adults: covered services and rates can differ from the Traditional plan, so eligibility should be checked before a visit is scheduled.
The PRISM lookup lets providers download the schedule by provider type and by date of service. That date is important: the same code can carry different rates for different service dates, and current downloads already show rates for future dates. When reconciling payments, pull the schedule for the date of service on the claim, not the date the claim was paid.
Units and rural differentials
Visits are paid per service; therapy, ABA, attendant care and nursing codes per 15-minute unit or per hour. Utah also distinguishes urban and rural areas for some payments, which is why the July 2026 reclassification of Cache County to urban status matters to providers there.
Provider types
Physicians, physician assistants and nurse midwives each have their own PRISM file. A practice employing several kinds of clinicians should model revenue by clinician type, since the same code may pay differently on each schedule.
| Code | What it is | Utah rate | Rank | National median |
|---|---|---|---|---|
| 99213 | Return visit, level 3 | $122.78 | 4 of 46 | $75.27 |
| 99214 | Return visit, level 4 | $157.92 | 5 of 46 | $108.69 |
| 99203 | New visit, level 2 | $54.78 | 44 of 46 | $92.17 |
| 90834 | Psychotherapy, 45 min | $127.95 | 7 of 47 | $92.09 |
| 90791 | Diagnostic evaluation | $43.72 | 43 of 44 | $141.74 |
| 97153 | ABA by a technician, 15 min | $19.67 | 12 of 42 | $15.86 |
New-patient visits lag return visits
Code 99203 pays $54.78 and has been unchanged since 2022-01-01, while most E/M codes were reset on 2026-07-01. Even 99215 at $151.98 pays less than 99214 at $157.92, and ranks only 21st. A practice that sees many new Medicaid patients will not see the same premium that return visits get.
Psychotherapy pays well, assessment does not
Code 90837 pays $159.23 an hour (10th of 48) and 90834 pays $127.95, but the diagnostic evaluation 90791 pays $43.72 and H0031 pays the same $43.72. Behavioral health clinics should budget intake visits at a fraction of the therapy hour.
Emergency and obstetric care
Emergency visit code 99285 pays $148.06 (16th of 48) and global obstetric code 59400 pays $2,362.93 (13th of 40).
Utah's flagship home and community rates are the headline for agencies:
- Utah personal care and attendant rates: S5125 at $21.21 per 15 minutes, $84.84 an hour, rank 1 of 27 and 178% above the national median. On the Traditional plan, personal care code T1019 pays $7.95 per 15 minutes ($31.80 an hour), 16th of 39.
- Utah private duty nursing: S9123 with modifier TN at $254.03 an hour, rank 1 of 43 and 363.2% above the national median of $54.84.
- Utah ABA rates: 97153 at $78.68 an hour, 24% above the median. Analyst-led 97155 pays $150.04 an hour, 8th of 41.
- Utah physical therapy: $119.72 an hour under 97110, 7th of 49 and 24.7% above the median.
- Hospice routine home care: $183.64 a day under T2042 from 2026-10-01, 1.6% below the median.
- Nursing facilities: a $248.23 daily rate built from case mix, property and a flat rate, effective 2026-10-01.
The 2026-07-01 effective date on most of these figures means Utah's schedule is current, not carried forward from old years.
Utah's managed-care rules are mostly negotiated. For physician services, radiology, pharmacy, laboratory, DME, vision, home health, hospital outpatient, therapy and behavioral health, plans negotiate; the published rate applies out of network. Two lines are firmer: for dental and hospital inpatient, plans must pay at least the published rate. Nursing facilities, home and community-based services, personal care, IDD services, transportation and ABA are paid directly by the state, outside managed care.
Of 21 service lines classified, the published rate binds plans on 5, and Utah has no directed payment programs on file. Named physical health plans include Molina Healthcare of Utah, SelectHealth Community Care, Healthy U, Health Choice Utah and Healthy Outcomes Medical Excellence (HOME). Dental plans include MCNA Dental and Premier Access Medicaid Dental, and county-based behavioral health plans include Salt Lake County Behavioral Health Services, Davis Behavioral Health and Bear River Mental Health Services. ModivCare is the NEMT broker. The Utah managed care page lists each rule.
The split is clean. Home care, IDD and ABA providers are paid the published waiver and state plan rates, so the strong figures above are what they receive. Physician and behavioral health providers contract with plans and should treat the PRISM rate as the out-of-network reference.
That gives physician practices a strong negotiating position on return visits, where the state pays above Medicare. It is weaker on new-patient visits and behavioral health assessments, where the state rate is low and a plan has little reason to pay more. Behavioral health clinics should also note that their county-based plan, not a statewide plan, holds the contract, so terms vary by county.
Utah announces changes in numbered MIB notices. The latest:
- MIB September 2026, 26-89: telehealth modifiers update, effective 2026-09-01.
- 26-92: Upper Payment Limit (UPL) project, effective 2026-09-01.
- 26-95: behavioral health code standardization, effective 2026-09-01, alongside a policy clarification on inpatient medical detoxification (26-93).
- 26-88, 26-90 and 26-96: community engagement requirements for hospital presumptive eligibility, changes to reporting of maternity care and behavioral health revenue code updates, all effective 2027-01-01.
- MIB July 2026: Cache County reclassified to urban status (26-63), dental services for pregnant, postpartum and EPSDT members (26-67), and a behavioral health codes rate rebase (26-71) recorded at 1.82%.
Three behavioral health notices in one year signal a substantial rework. The July rebase adjusted rates, and the two code standardization notices change which codes clinics use for which services. When codes are standardized, a service previously billed under one code may move to another with a different rate and unit, so a clinic's average payment per visit can change even when no single rate does.
Clinics should map each current service to its standardized code, compare old and new rates per hour, and check how their county plan contract references the state schedule. The January 2027 revenue code updates will add a further change for facility-based programs.
Utah's 99213 rate sits near the top of the Mountain West. Montana Medicaid pays more at $133.81 and New Mexico Medicaid pays $128.92, while Wyoming Medicaid pays $79.31. Colorado pays $73.99, Idaho $86.12, Arizona $48.68 and Nevada $47.47. On ABA, Utah's $19.67 per 15 minutes beats every neighbor except New Mexico, which pays $32.31.
Budget from the PRISM schedule for your provider type and date of service. Weight new and return visits separately, since they pay very differently. Home care and private duty nursing agencies can build wage plans on rates that lead the nation, but should track the waiver rate schedules for each program they serve. The full Utah file, with history back to 1985, is covered on pricing.
All 44,888 current Utah rates are compiled from official state Medicaid publications, and each rate links to its source document. Named sources include the Utah Medicaid Coverage and Reimbursement Lookup (PRISM) fee schedule downloads for the Traditional and Non-Traditional plans and for physicians, physician assistants, ambulatory surgical centers, podiatry, home health agencies, nurse midwives and maxillofacial surgery, the MS-DRG Payment Calculation (v43a) and the Utah Medicaid Nursing Home Rates. Our methodology explains rankings and per-hour conversions.