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Effective January 1, 2024, the Oregon Health Authority (OHA) increased fee-for-service (FFS) rates for services to treat handicapping malocclusion (HM) as follows:
- D8080: $3,947.00
- D8220: $210.00
- D8660: $276.00
- D8680: $290.00
- D8695: $143.00
As a reminder, CCO payments to providers for HM services are covered by the risk corridor described in the 2024 CCO contract. To be eligible for the risk corridor, all treatment for CCO members must follow FFS reimbursement and prior authorization requirements for orthodontic treatment of handicapping malocclusion. Risk corridor credit for CCO payment is limited to 120% of OHA’s FFS rates for covered services.
What should you do?
Update claim processing and make payments for orthodontia services consistent with FFS reimbursement effective January 1, 2024. This includes:
- Using the billing codes above to adjudicate claims for these
- Requiring prior authorization for all codes (except for D8660) and making authorization decisions consistent with OHA’s Orthodontia Review Criteria.
- Using a payment model consistent with the FFS model found in Oregon Administrative Rule 410- 123-1260(12) such as paying for services in one lump sum at the beginning of each phase of treatment. Alternative payment models that are considered in the risk corridor are subject to the reimbursement limit stated in the CCO contract.
Questions?
If you have questions about submitting encounter claims, please contact your CCO’s Encounter Data Liaison. For other inquiries, please contact your CCO’s Account Representative or Jessica Dusek, Medicaid Dental Policy Analyst, at Jessica.D.Dusek@oha.oregon.gov or 503-510-0252.
Join us Tuesday, February 13 from 10 to 11 a.m. Pacific Time
Community partners, coordinated care organizations, providers, insurers, and more are invited to learn more about how Oregon Health Authority (OHA) and Oregon Department of Human Services (ODHS) are working together to support people in Oregon as the federal COVID-19 PHE phases out.
Agenda:
- Medical renewals updates: Current status and national ranking; requests for information and ways members can respond
- Marketplace special enrollment period
- OHP Bridge: What to expect
- Questions and answers
- Resources for partners
Language and disability access: American Sign Language and live captioning will be available for this meeting. A separate Spanish webinar will be held Tuesday, February 27 at 10 a.m. Pacific Time.
Everyone has a right to know about and use ODHS and OHA programs and services. ODHS and OHA provide free help. For individuals with disabilities or individuals who speak a language other than English, OHA can provide information in alternate formats such as translations, large print, or braille. Contact the Feedback team at (503) 945-5488 or feedback@odhsoha.oregon.gov at least two business days in advance of the webinar if you would like assistance to participate. All relay calls accepted.
English registration: February 13 and May 14
Spanish registration: February 27 and May 30
View past webinar material at KeepCoveredPartners.Oregon.gov
- 1 p.m., January 30, 2024
- 1 p.m., February 13, 2024
- 1 to 2:30 p.m., February 8, 2024
- 1 to 2:30 p.m., February 15, 2024
- 1 to 2:30 p.m., February 22, 2024
- 10:30 a.m. to 12 p.m., March 6, 2024
- 1 to 2:30 p.m., March 14, 2024
- 10:30 to 11:30 a.m., March 19, 2024
Learn more about these RACs and the rulemaking process.
January 31, 2024
February 1, 2024
Please visit the committee and workgroup links below for more information about meetings. You can also view the OHA Public Meeting calendar.
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