Billing

Below is a list of standard charges provided by Utah State Hospital, per the Centers for Medicare and Medicaid Services (CMS) requirements. It is important to note that the charges reflected are the amounts Utah State Hospital would bill an insurer and it may not be what will be required to be paid out of pocket by the patient.

Hospital charges are the amount a hospital bills an insurer for a service. For most patients, hospitals are reimbursed at a level well below charges. Patients covered by Medicare or Medicaid programs have hospital reimbursement rates determined by federal and state governments. Hospital charges may also include bundled procedures, personnel, services and supplies. An example would be room rates that include the space, equipment, nursing personnel and supplies.

Patients can get answers to questions about billing and insurance by contacting the Business Office at (801) 344-4215.

Service Description	Billing Code	Standard Charge
Inpatient Psychiatric Hospitalization - Pediatric Population	0124	$1,687.50
Inpatient Psychiatric Hospitalization - Adult Population	0124	$ 937.50
Inpatient Psychiatric Hospitalization - Forensic Population	0124	$1,031.25
Psychiatric/psychological diagnostic interview without medical services (intake interview)	90791	$ 175.37
Psychiatric/psychological diagnostic interview with medical services (intake interview)	90792	$ 200.44
Group Psychotherapy	90853	$ 28.49
Psychotherapy, 30 minutes with patient and/or family member	90832	$ 81.16
Psychotherapy, 45 minutes with patient and/or family member	90834	$ 107.28
Psychotherapy, 60 minutes with patient and/or family member	90837	$ 158.35
Family psychotherapy (without the patient present) 50 minutes	90846	$ 115.54
Family psychotherapy (with the patient present) 50 minutes	90847	$ 120.67
Multiple-family group psychotherapy	90849	$ 34.45
Psychotherapy, 30 minutes with patient and/or family member when performed with an E&M service	90833	$ 75.74
Psychotherapy, 45 minutes with patient and/or family member when performed with an E&M service	90836	$ 95.88
Psychotherapy, 60 minutes with patient and/or family member when performed with an E&M service	90838	$ 127.01
Inpatient hospital visits: Initial and subsequent	99231	$ 57.46
Inpatient hospital visits: Initial and subsequent	99232	$ 91.45
Inpatient hospital visits: Initial and subsequent	99233	$ 137.59
Under Observation or Inpatient Care Services (Including Admission and Discharge Services)	99234	$ 113.41
Under Observation or Inpatient Care Services (Including Admission and Discharge Services)	99235	$ 184.92
Assessment of aphasia (includes assessment of expressive and receptive speech and language function, language comprehension, speech production ability, reading, spelling, writing, e.g., by Boston Diagnostic Aphasia Examination) with interpretation and report, per hour	96105	$ 112.01
Standardized cognitive performance testing (e.g., Ross Information Processing Assessment) per hour of a qualified health care professional’s time, both face-to-face time administering tests to the patient and time interpreting these test results and preparing the report	96125	$ 118.96
Developmental test administration (including assessment of fine and/or gross motor, language, cognitive level, social, memory, and/ or executive functions by standardized developmental instruments when performed), by a physician or other qualified healthcare professional, with interpretation and report; first hour	96112	$ 144.36
Each additional 30 minutes (List separately in addition to code for primary procedure)	96113	$ 66.08
Brief emotional/behavioral assessment (e.g., depression inventory, attention-deficit/hyperactivity disorder [ADHD] scale), with scoring and documentation, per standardized instrument	96127	$ 5.22
Neurobehavioral status exam (clinical assessment of thinking, reasoning and judgment, e.g., acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities), by a physician or other qualified healthcare professional, both face-to-face time with the patient and time interpreting test results and preparing the report; first hour	96116	$ 93.30
Each additional hour (List separately in addition to code for primary procedure)	96121	$ 77.99
Psychological testing evaluation services by physician or other qualified healthcare professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report and interactive feedback to the patient, family member(s) or caregiver(s), when performed; first hour	96130	$ 127.96
Each additional hour (List separately in addition to code for primary procedure)	96131	$ 89.10
Neuropsychological testing evaluation services by physician or other qualified healthcare professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report and interactive feedback to the patient, family member(s) or caregiver(s), when performed; first hour	96132	$ 123.86
Each additional hour (List separately in addition to code for primary procedure)	96133	$ 89.47
Psychological or neuropsychological test administration and scoring by physician or other qualified healthcare professional, two or more tests, any method, first 30 minutes	96136	$ 27.18
Each additional 30 minutes (List separately in addition to code for primary procedure)	96137	$ 20.99
Psychological or neuropsychological test administration and scoring by technician, two or more tests, any method; first 30 minutes	96138	$ 38.39
Each additional 30 minutes (List separately in addition to code for primary procedure)	96139	$ 39.50
Psychological or neuropsychological test administration, with single automated instrument via electronic platform, with automated results only	96146	$ 2.60

Utah State Hospital is considered an Institution for Mental Disease (IMD) under the Social Security Act. This policy states that Residents of an IMD who qualify for Medicaid or Medicare Cost Sharing must be under the age of 22 and over the age of 64 to receive benefits. A resident of the Utah State Hospital who was not a resident when they turned 21 is not eligible for benefits.

If residents of Utah State Hospital are age-eligible for Medicaid, our staff will assist patients with their Medicaid application. The Department of Workforce Services will process Medicaid applications and determine eligibility.

If approved for Medicaid, the Department of Workforce Services (DWS) transitions USH patients to “Nursing Home Medicaid.” Per Utah Medicaid policy 463 opens in a new tab, residents of a nursing facility must pay a cost-of-care contribution, unless they only receive Supplemental Security Income, or their income after allowed deductions, including the personal needs allowance, is zero. (See Table II-A opens in a new tab) The cost-of-care contribution helps pay for the services they receive at the hospital. It reduces the payment the Medicaid agency makes for their care.

If you do not agree with the decision made regarding your eligibility for assistance, you may request a fair hearing by filling out this opens in a new tab form. Please follow the instructions on the form carefully. There are time limits to request a fair hearing after you receive your decision notice.

Social Security disability, retirement, and survivors beneficiaries who are admitted to the Utah State Hospital generally have to apply all of their monthly benefits, excluding personal needs allowance, to the costs of their care. Utah Medicaid policy states that patients who are admitted to an institution for a long term stay are allowed to keep $45 per month of their social security for personal needs allowance.

Utah State Hospital is an approved organizational representative payee opens in a new tab for Social Security Benefits. USH policy in regards to SSA benefits states that the patient account manager submits a representative payee application for all USH patients receiving social security benefits. Your benefits are then used to pay for your cost of care. The remaining personal needs allowance is placed into a trust account.

If you are receiving Supplemental Security Income, your eligibility and benefit rate may change opens in a new tab. SSI beneficiaries benefits are reduced or suspended if necessary. In general, payment is limited to a maximum of $30 per month while you are a resident of USH. These changes are made directly by the Social Security Administration.

The Social Security Administration audits Utah State Hospital’s representative payee process and patient needs accounts yearly. If you have concerns about this process, please contact the USH patient account manager at (801) 344-4402. If you would like to dispute USH becoming your representative payee, please contact the Social Security Administration at 800-772-1213.

If you believe you’ve been wrongly billed, you may contact:

Revenue Cycle Manager
Utah State Hospital
P.O. Box 270
Provo, UT 84603-0270
(801) 344-4215

Utah Insurance Department
[email protected]
(801) 957-9200

The U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Washington, D.C. 20201
(877) 696-6775

Centers for Medicare and Medicaid Services
Denver Regional Office Phone: 303-844-2111

Visit https://www.cms.gov/nosurprises opens in a new tab for more information about your rights under federal law.

Financial Assistance

When applying for financial assistance, you will be asked to provide current financial information:

Financial assistance application
Letter explaining your current financial status
Copy of current bank statement
Copy of last year's tax return
Copies of paycheck stubs and/or other income from the past two (2) months

Please note that Utah State Hospital is unable to waive cost-sharing responsibility for Social Security recipients.

Financial Assistance Applications

How to Pay Your Bill

Walk In

Utah State Hospital - Heninger Administration Building
1300 E Center Street
Provo, UT 84606

Mon–Fri: 7:30 am–4:30 pm

Pay Your Bill By Mail

Utah State Hospital
Attn: Patient Accounts
PO BOX 270
Provo, UT 84603

Pay Your Bill Over the Phone

801-344-4140
You can talk to a representative on the phone Mon–Fri: 7:30 am–4:30 pm.