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DHS91073 Rate Table
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Last Revised: 07/01/2025
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Effective Date: 07/01/2025
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Psychotherapy Services
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Service NameMedicaid Billing CodeDHHS Service CodeUnit RateUnit
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Psychiatric Diagnostic Interview Examination90791 UCNCA$42.94Quarter Hour
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Psychotherapy, 30 minutes, with patient and/or family member90832 UCNT2$70.41Session
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Psychotherapy, 45 minutes, with patient and/or family member90834 UCNT3$125.66Session
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Psychotherapy, 60 minutes, with patient and/or family member90837 UCNT4$156.38Session
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Psychotherapy for crisis, first 60 minutes, with patient and/or family member90839 UCNTC$140.80Session
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Psychotherapy for crisis, add-on90840 UCNTX $70.41Half Hour
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Family Psychotherapy - without patient present90846 UCNFW$35.21Quarter Hour
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Family Psychotherapy - with patient present90847 UCNFT$35.21Quarter Hour
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Multiple-Family Group Psychotherapy90849 UCNFG$8.20Quarter Hour
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Group Psychotherapy90853 UCNGT $10.53Quarter Hour
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Mental Health Assessment By Non PhysicianH0031NCN$42.94Quarter Hour
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Clinical ConsultationN/ANCC$20.00Quarter Hour
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Non-Clinical ConsultationN/ANNC$13.30Quarter Hour
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Mileage & Travel Reimbursement (over 75 miles round trip)N/AMIR$1.07Mile
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Psychological and Neuropsychological Evaluation Services
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Service NameMedicaid Billing CodeDHHS Service CodeUnit RateUnit
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Assessment of Aphasia96105 UCNXA $72.31Hour
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Developmental Testing (Limited)96110 UCNDL$7.87Exam
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Developmental Test Administration - 1st Hour96112 UCNDT $162.24Hour
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Developmental Test Administration – Each Additional Half Hour96113 UCND2 $81.12Half Hour
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Neurobehavioral Status Examination - by Physician or Qualified Health Care Professional - 1st Hour96116NXB$171.46Hour
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Neurobehavioral Status Examination – by Physician or Qualified Health Care Professional – Each Additional Hour96121NB2$171.46Hour
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Standardized Cognitive Performance Testing by a Health Care Professional - per hour96125 UCNST $76.80Hour
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Psychological Testing Evaluation by Physician or Qualified Health Care Professional - 1st Hour96130NP1$171.46Hour
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Psychological Testing Evaluation by Physician or Qualified Health Care Professional - Each Additional Hour96131NP2$171.46Hour
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Neuropsychological Testing Evaluation by Physician or Health Care Professional - 1st Hour96132NP3$171.46Hour
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Neuropsychological Testing Evaluation by Physician or Health Care Professional - Each Additional Hour96133NP4$171.46Hour
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Psychological or Neuropsychological Testing by Physician or Health Care Professional - 1st Half Hour96136NP5$85.72Half Hour
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Psychological or Neuropsychological Testing by Physician or Health Care Professional - Each Additional Half Hour96137NP6$85.72Half Hour
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Psychological or Neuropsychological Testing by Technician - 1st Half Hour96138NP7$28.51Half Hour
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Psychological or Neuropsychological Testing by Technician - Each Additional Half Hour96139NP8 $28.51Half Hour
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Psychological or Neuropsychological Testing by Electronic Platform - Auto Result96146NP9$1.56Exam
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Clinical ConsultationN/ANCC$20.00Quarter Hour
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Mileage & Travel Reimbursement (over 75 miles round trip)N/AMIR1.07Mile
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Pharmacologic Evaluation and Management Services
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Service NameMedicaid Billing CodeDHHS Service CodeUnit RateUnit
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Pharmacologic Management, Prescriber (MD/APRN) (based on complexity and time, 5 Minutes typical)99211 CG NM1$52.72Session
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Pharmacologic Management, Prescriber (MD/APRN) (based on complexity and time, 10 Minutes typical)99212NM2 $42.05Session
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Pharmacologic Management, Prescriber (MD/APRN) (based on complexity and time, 15 Minutes typical)99213 CGNM3$120.59Session
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Pharmacologic Management, Prescriber (MD/APRN) (based on complexity and time, 25 Minutes typical)99214 CGNM5$155.10Session
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Pharmacologic Management, Prescriber (MD/APRN) (based on complexity and time, 40 Minutes typical)99215NM8$134.03Session
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Home Services E/M Codes – established patient - 15 Minutes99347NH1$34.26Session
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Home Services E/M Codes – established patient - 25 Minutes99348 CGNH2 $120.59Session
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Home Services E/M Codes – established patient - 40 Minutes99349 CGNH3 $120.59Session
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Home Services E/M Codes – established patient - 60 Minutes99350NH4$142.30Session
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Psychiatric Diagnostic Evaluation with Medical Services, by physician or APRN90792NPE$42.94Quarter Hour
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Psychotherapy add-on code, witha patient and/or family member - 30 mins (added to applicable E/M service code)90833NMT $70.41Session
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Psychotherapy add-on code, with a patient and/or family member - 45 mins (added to applicable E/M code)90836NMI $105.61Session
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Psychotherapy add-on code, with a patient and/or family member - 60 mins (added to applicable E/M code)90838NMC $140.80Session
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Mental Health Assessment By Non PhysicianH0031NCN$42.94Quarter Hour
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Nurse Assessment/EvaluationT1001NAE$51.90Session
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Therapeutic, Prophylactic, or Diagnostic Injection, Subcutaneous/Intramuscular96372NDI$10.67Session
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Clinical ConsultationN/ANCC$20.00Quarter Hour
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Mileage & Travel Reimbursement (over 75 miles round trip)N/AMIR$1.07Mile
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Psychosocial Rehabilitative Services
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Service NameMedicaid Billing CodeDHHS Service CodeUnit RateUnit
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Individual Skills Training and Development (Psychosocial rehabilitative services with an individual)H2014NRI$19.32Quarter Hour
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Group Psychosocial Rehabilitative ServicesH2017NRG$6.78Quarter Hour
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Group Psychosocial Rehabilitative Services - IntensiveH2017 U1NRX$7.76Quarter Hour
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Non-Clinical ConsultationN/ANNC$13.30Quarter Hour
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Mileage & Travel Reimbursement (over 75 miles round trip)N/AMIR$1.07Mile
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Therapeutic Behavioral Services
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Service NameMedicaid Billing CodeDHHS Service CodeUnit RateUnit
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Individual/Family Therapeutic Behavioral ServicesH2019NBT$28.41Quarter Hour
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Group Therapeutic Behavioral ServicesH2019 HQNBG$9.67Quarter Hour
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Non-Clinical ConsultationN/ANNC$13.30Quarter Hour
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Mileage & Travel Reimbursement (over 75 miles round trip)N/AMIR$1.07Mile
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Family and Youth Peer Support Services
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Service NameMedicaid Billing CodeDHHS Service CodeUnit RateUnit
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Peer Support Services, individual - per 15 minsH0038NPS$21.16Quarter Hour
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Mileage at Standard Rate of Reimbursement (over 60 miles round trip)N/AMSRhttps://hs.utah.gov/DHHSpurchasing/mileage
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Evidence-Based Program Models for Prevention of Foster Care Services
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Service NameMedicaid Billing CodeDHHS Service CodeUnit RateUnit
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Parent-Child Interaction Therapy - Provided by a therapist who is certified or trained and working toward certification by PCIT International N/APCE$37.50Quarter Hour
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Trauma Focused Cognitive Behavior TherapyN/ATFT$36.24Quarter Hour
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Functional Family TherapyN/AFFT$220.00Session
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Motivational InterviewingN/AMIT$36.24Quarter Hour
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Mileage & Travel Reimbursement (over 75 miles round trip)N/AMIR$1.07Mile
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Mentoring Services
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Service NameMedicaid Billing CodeDHHS Service CodeUnit RateUnit
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Mentoring (1:1)N/AMT1$11.20Quarter Hour
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Mentoring (1:2)N/AMT2$5.60Quarter Hour
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Mentoring (1:3)N/AMT3$3.74Quarter Hour
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Mileage at Standard Rate of Reimbursement (over 60 miles round trip)N/AMSRhttps://hs.utah.gov/DHHSpurchasing/mileage
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Staff Assistance AddedN/ASAA$5.00Quarter Hour
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Day Treatment Services
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Service NameMedicaid Billing CodeDHHS Service CodeUnit RateUnit