Effective 1/1/2022. Copyright Notice: Current Dental Terminology © 2021-2022 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.

"Not covered" codes are not part of the OHP Plus benefit package, or are for services that are incidental to another service and not reimbursed separately. Where applicable, please refer to Prioritized List placement, Guideline Notes and OARs listed for each code for complete information regarding benefit coverage and limitations.

For services billed as medical, use the CMS-1500 claim format, CPT/HCPCS codes and ICD-10-CM diagnosis codes. (This list may not note every dental code that has a corresponding medical code.)

To find fee-for-service reimbursement rates, view the OHP Fee-for-Service Fee Schedule at http://www.oregon.gov/oha/hsd/ohp/pages/fee-schedule.aspx. This schedule represents a given point in time and may not include payable codes that were added to MMIS after the posted fee schedule date.

The outlier, interim rate and unit values assigned to each Oregon DRG hospital.

List of diagnosis codes covered for emergency services billed under the Citizenship Waived Medical (CWM) benefit package. To learn more about CWM coverage, see Oregon Administrative Rule 410-134-0005.

The inpatient and outpatient interim rates for Oregon Type A and B Hospitals

This lists all organizations that have received a grant under House Bill 2402 to help homeless individuals obtain a copy of their birth certificate at no cost. If you have questions about this data, please email leila.ortega@oha.oregon.gov.

This lists all organizations that have received a grant under House Bill 2402 to help homeless individuals obtain a copy of their birth certificate at no cost.

Diagnosis codes for Other Provider-Preventable Conditions as defined in Oregon Administrative Rule 410-125-0450(2).

Current codes (with an end date of 12/31/2299) in this group are covered when billed with a current code from the Diagnostic Workup File (Code Group 6032). Codes with other end dates are for historical purposes only. This list does not guarantee coverage. For specific information, call Provider Services at 800-336-6016.

Codes that are not subject to Oregon Administrative Rule 410-125-0410(2), which states that hospitals must do a single billing for patients "whose discharge and readmission to the hospital is within thirty (30) days for the same or related diagnosis."