CurrentUtah MedicaidPolicy N/A

Utah Medicaid Traditional Healing

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This policy governs Utah Medicaid coverage, provider eligibility, coding, and reimbursement for traditional healing services delivered at or through eligible Indian Health Service, Tribal, or Urban Indian facilities.

Policy Summary

PayerUtah Medicaid

PolicyTraditional Healing

Policy CodePolicy N/A

Change TypeAdded coverage and reimbursement

Effective DateOctober 1, 2026

Next Review DateN/A

Key ActionBill traditional healing through the fee-for-service model using the OMB IHS All-Inclusive Rate per encounter, not as a separate encounter.

SourceLink

POLICY UPDATE CHANGES

Utah Medicaid adds coverage and reimbursement for traditional healing services rendered at or through an eligible I/T/U facility.

5 yearsCMS demonstration duration

I/T/UEligible facility types

AIRReimbursement method

H0051Traditional healing code

0509Facility revenue code

Traditional Healing Coverage and Reimbursement

Traditional healing services are covered and reimbursed when ALL of the following criteria are met:

ALL of the following

The service is provided under the Utah Medicaid traditional healing expenditure authority for traditional health care practices across eligible I/T/U providers.
The service is rendered at or through an eligible I/T/U facility.
The traditional healer is employed by or contracted with the eligible I/T/U facility.
The traditional healer meets the qualification standards, training requirements, and experience requirements established by the I/T/U facility or Tribe, which retains sole authority to determine who qualifies as a traditional healer.

Policy Summary

PayerUtah Medicaid

PolicyTraditional Healing

Policy CodePolicy N/A

Change TypeAdded coverage and reimbursement

Effective DateOctober 1, 2026

Next Review DateN/A

Key ActionBill traditional healing through the fee-for-service model using the OMB IHS All-Inclusive Rate per encounter, not as a separate encounter.

SourceLink

On This Page

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CurrentUtah MedicaidPolicy N/A

Utah Medicaid Traditional Healing

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Sign up for all Utah Medicaid policy alerts

Know when Utah Medicaid releases new policies or updates existing guidance.

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Policy Summary

PayerUtah Medicaid

PolicyTraditional Healing

Policy CodePolicy N/A

Change TypeAdded coverage and reimbursement

Effective DateOctober 1, 2026

Next Review DateN/A

Key ActionBill traditional healing through the fee-for-service model using the OMB IHS All-Inclusive Rate per encounter, not as a separate encounter.

SourceLink

POLICY UPDATE CHANGES

Utah Medicaid adds coverage and reimbursement for traditional healing services rendered at or through an eligible I/T/U facility.

5 yearsCMS demonstration duration

I/T/UEligible facility types

AIRReimbursement method

H0051Traditional healing code

0509Facility revenue code

Traditional Healing Coverage and Reimbursement

Traditional healing services are covered and reimbursed when ALL of the following criteria are met:

ALL of the following

The service is provided under the Utah Medicaid traditional healing expenditure authority for traditional health care practices across eligible I/T/U providers.
The service is rendered at or through an eligible I/T/U facility.
The traditional healer is employed by or contracted with the eligible I/T/U facility.
The traditional healer meets the qualification standards, training requirements, and experience requirements established by the I/T/U facility or Tribe, which retains sole authority to determine who qualifies as a traditional healer.

Policy Summary

PayerUtah Medicaid

PolicyTraditional Healing

Policy CodePolicy N/A

Change TypeAdded coverage and reimbursement

Effective DateOctober 1, 2026

Next Review DateN/A

Key ActionBill traditional healing through the fee-for-service model using the OMB IHS All-Inclusive Rate per encounter, not as a separate encounter.

SourceLink

On This Page

Billing Codes and Reimbursement

Traditional healing service codeHCPCSCovered

H0051

Open code for traditional healing

Traditional healing facility revenue codeRevenueCovered

0509	Open revenue code to report a service performed in an outpatient hospital or facility

Reimbursement rate

RateOMB IHS All-Inclusive Rate (AIR) per encounter

Delivery modelFee-for-Service

Separate encounter billingTraditional healing is included in the standard medical encounter AIR and is not billed as a separate, distinct encounter

Provider Billing and Compliance Actions

Billing Rule

Verify Traditional Healer and Facility Eligibility

Verify that each traditional healer is employed by or contracted with an eligible I/T/U facility. Services must be rendered at or through an eligible I/T/U facility, and the facility or Tribe retains authority to determine the healer’s qualifications, including applicable training and experience standards.

Billing Rule

Use Required Service and Revenue Codes

Report traditional healing services using the required service and revenue codes when applicable.

Use HCPCS H0051.
Use revenue code 0509 when reporting the service in an outpatient hospital or facility setting.

Billing Rule

Apply Encounter-Based Reimbursement

Bill traditional healing through fee-for-service using the OMB IHS All-Inclusive Rate (AIR) per encounter. H0051 is reimbursed as part of the standard medical encounter AIR and must not be reported as a separate, distinct encounter.

If traditional healing is the only medical service provided on a day, reimburse it at the standard AIR rate.

Note

Maintain Beneficiary Protections

Maintain beneficiary protections when providing traditional healing services. Beneficiaries must retain access to clinical alternatives, make a voluntary choice regarding traditional healing, and receive all standard Medicaid benefits and protections.

Do not restrict access to clinically appropriate alternatives.
Respect the beneficiary’s voluntary choice to receive traditional healing services.
Preserve standard Medicaid beneficiary protections and benefits.

Key Terms

I/T/U facilities

IIndian Health Service

TTribal facilities

UUrban Indian facilities

EligibilityFacilities eligible to provide or support traditional healing services

AIR

Full termOMB IHS All-Inclusive Rate

PurposeUsed to reimburse a standard medical encounter

Traditional healingIncluded in the rate and does not constitute a separate, distinct encounter

Traditional healer

RolePractitioner providing traditional healing services

QualificationsDetermined by an I/T/U facility or Tribe, including qualification, training, and experience standards

Relationship to facilityEmployed by or contracted with an eligible I/T/U facility