Most codes in this group do not appear on the Prioritized List of Health Services; however, they are covered when billed with a diagnosis code from OHP's Diagnostic Workup File (Code Group 6032). This list does not guarantee coverage. For specific coverage information, call the Provider Services Unit at 1-800-336-6016.

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.

Codes in this file are considered ancillary (defined as “services supportive of or necessary for providing a primary service”). Ancillary services may be provided either before, after, or concurrent with the primary service. For example, anesthesia during surgery is a concurrent ancillary service. Community support services provided before or after behavioral health therapy is also ancillary, but not concurrent.

Ancillary codes are covered when they are medically appropriate and 1) part of the care for a funded (“above the line”) condition; or 2) part of a covered diagnostic workup. Payment for ancillary codes varies by program. For example, some codes may be bundled for payment or OHP may require a different coding option. See program rules for details.

This list is for reference purposes only. This list does not guarantee coverage. For specific coverage information please contact the Provider Services Unit at 1-800-336-6016.

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 410-134-0003.

Codes in this group do not appear on the Prioritized List; however, they are covered by OHP's FFS program when billed with a procedure code from OHP's Diagnostic Procedures code group (Code Group 1119).

Codes in this group are not on the Prioritized List. They are considered informational only. They may be needed for reporting purposes but they are not eligible for reimbursement by OHP's FFS program. For specific coverage information please contact the Provider Services Unit at 1-800-336-6016.

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 or comments about this data, please email amh.web@dhsoha.state.or.us.

Codes in this group are not on the Prioritized List. They are not specific enough for OHP to determine coverage. As such they are not eligible for reimbursement by OHP's FFS program. Providers are directed to bill with a more definitive diagnosis code. This list does not guarantee coverage. For specific coverage information please contact the Provider Services Unit at 1-800-336-6016.