| Past Prioritized List |
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| October 1, 2005 |
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October 1, 2005 Prioritized List of Health Services (pdf)
This list became effective on 10/1/2005. The funding level provides coverage through line 546. For your convenience, the corresponding Condition Index (pdf) and Treatment Index (pdf) may be accessed by clicking on the desired index.
- An ICD-9-CM code (pdf) and a CPT-4/HCPCS code (pdf) are now available to view the placement of individual codes on the April 1, 2005 List. Click on the desired link to view a searchable PDF file sorted by code. Note that the ICD-9-CM file includes all codes appearing on the List in addition to any valid fourth- or fifth-digit codes that are subsumed within those codes. For example, the three-digit code 860 appears on line 5 of the Prioritized List and this file will include codes 860, 860.0, 860.1, 860.2, 860.3, 860.4, 860.5. In this way the inclusion of 860 indicates that all valid fourth-digit codes are present on the line (i.e., 860.6-860.9 are not valid codes and therefore are not included).
The CPT-4/HCPCS file now includes both medical and surgical CPT-4 codes and all HCPCS codes appearing on the list. All codes are listed individually except where the standard set of medical therapy codes appear on a line. This standard set of codes is 90471-90472, 90780-90799, 90901-90937, 90945-91105, 91122-92060, 92070-92353, 92358-92371, 92502-92504, 92511-92606, 92610-92960, 92970-92977, 93000-93662, 93701-93790, 93875-95075, 95115-95999, 96100-96117, 96400-96999, 97504-97537, 97601-97750, 97799, 99050-99054, 99058-99078, 99175, 99185-99362, 99374-99375, 99379-99440, 99499 and will be represented in the file as "9xxxx". Should any of these codes appear on a line that does not include the full set of medical therapy codes shown above, they will be listed individually. Also, any codes that are not included in this set of codes (e.g., 92065) will be listed separately in addition to 9xxxx if they appear on the same line.
The code lists are only included here for assistance to those who wish to search the list by code. Please refer to the October 1, 2005 Prioritized List of Health Services (pdf) for the official definition of each line item. If any discrepancies are found please email to report them to us.
- Also available are an ICD-9-CM code (txt) and CPT-4/HCPCS code (txt). These files are in a tab-delimited text file format for downloading and contain the same information as describe above with one exception. Whereas the PDF file for ICD-9-CM placement includes the decimal point to aid in searching, the text file omits the decimal point. This is because of the assumption that the text file will be used to load into a database file, in which case the decimal point is usually not included.
As the Office of Medical Assistance Programs (OMAP) had not receive written approval of the 2005-07 Prioritized List of Health Services as of September 28, 2005, implementation of the list dated April 1, 2005 will continue through December 31, 2005 with only the following modifications effective October 1, 2005:
Line 350
ADD 327.20 Organic sleep apnea, unspecified
ADD 327.21 Primary central sleep apnea
ADD 327.23 Obstructive sleep apnea
ADD 327.24 Idiopathic sleep related non-obstructive alveolar hypoventilation
ADD 327.26 Sleep related hypoventilation/hypoxemia in conditions classifiable elsewhere
ADD 327.27 Central sleep apnea in conditions classified elsewhere
ADD 327.29 Other organic sleep apnea
Line 497
ADD 259.5 Androgen insensitivity syndrome
Line 27, 123,140, 275, 307
ADD 78811 Tumor imaging, positron emission tomography, limited area
ADD 78814 Tumor imaging, positron emission tomography, with concurrent CT for
attenuation correction and anatomical localization; limited area
Line 27,123,140,275
ADD 78812 Tumor imaging, positron emission tomography, skull base to mid-thigh
ADD 78813 Tumor imaging, positron emission tomography, whole body
ADD 78815 Tumor imaging, positron emission tomography, with concurrent CT for
attenuation correction and anatomical localization; skull base to mid-thigh
ADD 78816 Tumor imaging, positron emission tomography, with concurrent CT
for attenuation correction and anatomical localization; whole body
Line 184
ADD S0613 Clinical breast exam without pelvic exam
It should be noted that there were a number fifth-digit ICD-9-CM codes, in addition to those shown above, that were approved by the Centers for Medicare and Medicaid Services (CMS) to take effect on October 1, 2005. In those cases where a new fourth- or fifth-digit ICD-9-CM code is going into effect and its parent third- or fourth-digit code already appears on the list, no change to the list is necessary. It has always been the policy that the appearance of a third- or fourth-digit ICD-9-CM code on a line item represents the inclusion of any valid codes of higher specificity subsumed by it.
The 2005-07 Prioritized List of Health Services appearing in the Health Services March 2005 Report to the Governor and 73rd Oregon Legislative Assembly, along with all interim modifications included in the notification letter to legislative leadership dated July 23, 2005, will be implemented beginning on January 1, 2006. This new list will have a funding level that covers services appearing on lines numbered 1 - 530 out of the 710 lines. This funding level is equivalent to the funding line drawn at line 546 (out of 730) on the current list because of the merging of a number of lines that took place during the most recent biennial review of the list. Please contact Darren Coffman at (503) 378-2422 x413 if you have additional questions related to this matter.
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