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OHP FFS Fee Schedule Downloads
The Fee-for-Service (FFS) fee schedules are available in text, PDF, or Excel format. Please use the most current fee schedule posted by DMAP. All previous files are for reference only. For information about 2009 fee schedule format changes and recent corrections, click here (updated 11/9/09).
If you have questions about downloading the fee schedule, or comments or suggestions about the 2009 file formats, e-mail dmap.info@state.or.us
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2009 files
The 2009 fee schedules are from the replacement Medicaid Management Information System (MMIS). Beginning in March 2009, DMAP aims to post fee schedules every other month. The schedules posted here reflect only codes that are open for FFS payment during the month listed. Only codes with rate changes in 2009 will show a 2009 begin date.
- For information on rates and covered procedures for chemical dependency and mental health services, go the the AMH Tools for Providers page.
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2008 files
The 2008 fee schedules are from the legacy MMIS. Not all of this information is applicable to the replacement MMIS (for example, TOS).
LAP Dental Hygienists have a separate fee schedule (effective 10/08): PDF or Excel (TOS M only).
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2007
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2006
NOTE: Data for July 2006 through December 2006 is not available.
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Current file specifications (2009 and later)
This table lists the fields in the current MMIS FFS fee schedule, as read from left to right. Type of service has been replaced by modifiers where appropriate. A procedure code in combination with any applicable modifier is uniquely associated with a specific price.
Field |
Description |
Procedure Code |
Procedure Code - For billing purposes, DMAP uses Current Procedural Terminology (CPT), Level III National Codes (HCPCS) and Current Dental Terminology (CDT). |
Description |
Procedure code description |
Modifier 1 |
First modifier associated with procedure code. (Blank indicates no modifier.) |
Modifier 2 |
Second modifier associated with procedure code. (Blank indicates no modifier.) |
ASC |
A "Y" in this field indicates that this rate is an ambulatory surgical rate. If this field is blank, the rate is not an ambulatory surgical rate. |
Price |
Price effective during month reported. This column now contains the decimal point where appropriate. |
Effective Date |
Date current price became effective (YYYYMMDD) |
Procedure codes
DMAP uses the following types of procedure codes:
- Current Dental Technology (CDT) - CDT codes are five-character, alpha-numeric configurations (e.e., D2110). The CDT contains the American Dental Association's (ADA) Code on Dental Procedures and Nomenclature ("the Code"). The ADA updates this guide biennially, at the start of odd-numbered years. Contact the ADA for a current copy of the CDT. CDT (including procedure codes, definitions [descriptors] and other data) is copyrighted by the ADA. ©2008 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.
- Current Procedural Terminology (CPT) - CPT codes are five-character, numeric configurations (e.g., 99215). The CPT User Manual contains the American Medical Association's (AMA) Physicians' Current Procedural Terminology. The AMA reviews and revises CPT codes annually. Contact the AMA for a current copy of the CPT User Manual.
- Healthcare Common Procedure Coding System (HCPCS) - HCPCS codes are five characters with on alpha and four numeric configurations (e.g., A0042). The HCPCS User Manual contains the HCPCS Level II national codes, which are also published in the Federal Register. The Centers for Medicare and Medicaid Services (CMS) reviews and revises these codes annually. Contact any publishing compnay that provides medical coding reference books to obtain a current copy of the HCPCS User Manual.
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Legacy file specifications (2008 and earlier)
This table lists the fields in the legacy MMIS FFS fee schedule, as read from left to right. "Start" indicates where the field begins; "Length" indicates the length of the field. For example, the "TOS" field begins in column 1 of the fee schedule and is one character long.
Field |
Description |
Start |
Length |
TOS |
Type Of Service - See code descriptions. |
1 |
1 |
Proc |
Procedure Code - For billing purposes, DMAP uses Current Procedural Terminology (CPT), Level III National Codes (HCPCS) and Current Dental Terminology (CDT). |
2 |
5 |
Description |
Procedure code description |
7 |
32 |
Eff Dt |
Effective Date |
39 |
6 |
Price |
This column does not include the decimal: An item priced at $22.64 will show as 2264. The decimal needs to be placed two places in from the right of this column. |
45 |
7 |
PAC |
Pricing Action Code — See code descriptions. |
52 |
1 |
PA |
Prior Authorization — This field contains a YES for procedures requiring PA. |
56 |
1 |
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Types of service code descriptions for legacy fee schedules (2008 and earlier)
The following codes are used in the "TOS" field of the legacy MMIS FFS fee schedule.
|
TOS |
Service |
Definition |
K |
Lab/Radiology & Pathology |
Full Fee (P+T=K) |
P |
Lab/Radiology & Pathology |
Professional component (modifier 26) |
T |
Lab/Radiology & Pathology |
Technical component (modifier TC) |
A |
DME/Supplies |
Purchase |
B |
DME/Supplies |
Rental |
C |
DME/Supplies |
Repair |
8 |
Assistant Surgeon |
20% of the primary surgical rate |
H |
Ambulatory Surgical Centers |
Level of Care Facility rate |
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Pricing Action Codes for legacy fee schedules (2008 and earlier)
The following codes are used in the "PAC" field of the legacy MMIS FFS fee schedule:
PAC |
DESCRIPTION |
3 |
Pay the lesser of DMAP's Level 3 rate times the quantity or billed amount. |
4 |
Pay at 51% of the billed amount. |
5 |
Manually priced by DMAP; supporting documentation required. |
6 |
Documentation required; pay the lesser of DMAP's Level 3 rate or the billed amount. |
9 |
Service not covered in fee-for-service arena or is an invalid code. Verify code. Check to see if managed care is capitated for this service. |
A |
Pay as billed (invoice unit rate times quantity billed on invoice equals the billed amount). |
D |
Invalid procedure code for the type of service billed. |
N |
Procedure code is obsolete for the date of service. |
P |
Service is not covered. |
T |
Procedure code billed is a temporary code or a code used for tracking medical services; not covered. |
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