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As we work together to stop the spread of COVID-19 at home, work and in the community, we want to make sure you have the resources you need to keep informed, healthy and safe. If you have any questions about OHP and COVID-19, please let us know.
Updates for Oregon Health Plan providers
Pfizer and Moderna COVID-19 bivalent booster vaccine administration for ages 12 and older, effective 9/1/2022: Providers may now bill for the administration of these vaccines using procedure codes 0124A (Pfizer, 12 years and older) and 0134A (Moderna, 18 years and older).
The booster targets Omicron variants BA.4 and BA.5. Doses are supplied at no cost through the federal distribution system.
Please continue to refer to the Oregon Medicaid COVID-19 Provider Guide for information related to OHP and CWM coverage of vaccine, testing, screening, treatment and telemedicine services; OHP and CWM eligibility; and other information and resources related to providing and billing for covered services during COVID-19.
 Fact sheet updates: Bivalent boosters
Masking requirements in health care settings
 Webinar series: Preparing for the end of the federal COVID-19 Public Health Emergency continues Oct. 18 and Nov. 15, 2022
Please help share this learning opportunity with community partners, coordinated care organizations, providers, insurers, and others who work with Oregon Health Plan (OHP) members or people who receive Oregon Department of Human Services (ODHS) benefits.
- These monthly webinars will provide information and tools that partners can use to help OHP members and people who receive ODHS benefits prepare for potential changes once the federal COVID-19 Public Health Emergency ends.
- Sessions will be Tuesdays, 10 to 11 a.m. Pacific Time.
Complete Agreement to Pay forms before providing non-covered services to CWM members on or after July 1, 2022
As of July 1, 2022, providers may only bill Citizenship Waived Medical (CWM) members for non-covered services when the member agrees to pay for them by signing an Agreement to Pay form that lists the services.
- OHP 4109 for planned community births,
- OHP 3166 for prescriptions, and
- OHP 3165 for other health care services.
Oregon Administrative Rule (OAR) 410-134-0003 describes what the CWM benefit plan does and does not cover.
If the Agreement to Pay form is not signed by the member, the provider cannot bill the member for any non-covered services provided (OAR 410-120-1280 (5)(d)).
 Provider resource updates
Fee-for-service maximum allowable rates (medical/dental): Updated 9/21/2022
Novel Coronavirus Coding: Updated 9/21/2022
Medical-Dental Fee Schedule: Updated 9/20/2022
Community Integration Services Guide for Substance Use Disorder Programs: Updated 9/16/2022
 Recent rule revisions
OAR 410-200-0315: Financial Eligibility Guidelines for HSD Medical Programs
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