This document pertains to services provided on or after January 1, 2020. Copyright Notice: Current Dental Terminology © 2020 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.

Oregon hospitals report facility-wide MRSA BSIs as part of Oregon’s mandatory healthcare-associated infections reporting program. For information regarding standardized infection ratio baselines, please see https://www.cdc.gov/nhsn/2015rebaseline/index.html

Oregon hospitals report facility-wide hospital-onset CDIs as part of Oregon’s mandatory healthcare-associated infections reporting program. For information regarding standardized infection ratio baselines, please see https://www.cdc.gov/nhsn/2015rebaseline/index.html

Current codes (ending in 12/31/2299) in this group are informational only. They may be needed for reporting purposes, but the Oregon Health Plan's fee-for-service program does not cover them. Codes with other end dates are for historical purposes only. For specific coverage information please call Provider Services at 800-336-6016.

Oregon hospitals report facility-wide hospital-onset CDIs as part of Oregon’s mandatory healthcare-associated infections reporting program. For information regarding standardized infection ratio baselines, please see https://www.cdc.gov/nhsn/2015rebaseline/index.html

Oregon hospitals report CLABSIs from adult, pediatric, and neonatal intensive care units, and adult and pediatric medical, surgical, and medical/surgical wards as part of Oregon's mandatory healthcare-associated infections reporting program. For information regarding standardized infection ratio baselines, please see https://www.cdc.gov/nhsn/2015rebaseline/index.html.

Oregon hospitals report CAUTIs from adult and pediatric intensive care units, and adult and pediatric medical, surgical, medical/surgical, and inpatient rehabilitation wards as part of Oregon's mandatory healthcare-associated infections reporting program. For information regarding standardized infection ratio baselines, please see https://www.cdc.gov/nhsn/2015rebaseline/index.html

Oregon hospitals report CLABSIs from adult, pediatric, and neonatal intensive care units, and adult and pediatric medical, surgical, and medical/surgical wards as part of Oregon's mandatory healthcare-associated infections reporting program. For information regarding standardized infection ratio baselines, please see https://www.cdc.gov/nhsn/2015rebaseline/index.html.

Combined bloodstream infections at dialysis centers

Oregon hospitals report CAUTIs from adult and pediatric intensive care units, and adult and pediatric medical, surgical, medical/surgical, and inpatient rehabilitation wards as part of Oregon's mandatory healthcare-associated infections reporting program. For information regarding standardized infection ratio baselines, please see https://www.cdc.gov/nhsn/2015rebaseline/index.html