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Past Prioritized List
January 1, 2010
Updated 7-21-10
 

January 1, 2010 Prioritized List of Health Services (pdf)
Extracted Mental Health and Chemical Dependency Lines (pdf) 
Errata for January 1, 2010 Prioritized List of Health Services (pdf) Updated 7-21-10


The 2010-11 Prioritized List of Health Services, reflective of the work documented in the Health Services Commission's 2009 Report to the Governor and 75th Oregon Legislative Assembly, go into effect on January 1, 2010.  This list reflects all interim modifications made to the 2008-09 Prioritized List through October 1, 2009.  The following additional changes of note are included in this list:

a)  Autism Spectrum Disorders (ASD) is split out from Chronic Organic Mental Disorders including Dementias (10/1/09 Line 210) into new Line 210.  New Guideline Note 75 provides clarification on the services for ASD included in this new line.

b)  Treatment of all urinary system calculus (e.g., kidney stones) is combined on Line 376 (from lines 187, 376, and 418 of 10/1/09 list).

c)  2008-09 Lines 71 (Comfort Care) and 608 (Obesity services not appearing on new Lines 8 and 33) have been removed from the list and all lines are renumbered.  These line deletions took effect on October 1, 2007, and October 1, 2009, respectively, but have continued to appear on the list in strikethrough text to this point.

d)  Partial resin dentures (Line 498) were moved from 10/1/09 Line 660 and partial cast metal dentures (Line 658) were moved from 10/1/09 Line 499 (i.e., they switched places).

e)  Statements of Intent on Treatment of Cancer Provided Near the End of Life with Little or No Benefit, Hospitalization for Acute Viral Infections, and Nerve Blocks are now identified as Guideline Notes 12, 61, and 76, respectively.

The changes indicated above result in a net reduction of two lines, meaning the 2010-11 list includes 678 lines (down from 680), with a funding line that covers all services appearing on lines 1-502 (as opposed to 503).  The change in the funding line number from 503 to 502 does not result in a reduction in covered services, but only occurs as a result of the changes described in (a) through (d).

An ICD-9-CM code (pdf) file and a CPT-4/HCPCS code (pdf) file are available to view the placement of individual codes on the January 1, 2010 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 153 of the Prioritized List and this file will include codes 860, 860.0, 860.1, 860.2, 860.3, 860.4, and 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), even though 860 itself is not a billable code.

The CPT-4/HCPCS file includes both medical and surgical CPT-4 codes and all HCPCS codes appearing on the list.  All codes are listed individually, including the standard set of medical therapy codes that were previously represented as “99xxx.”

Also available are an ICD-9-CM code without decimal (txt) file, ICD-9-CM code with decimal (txt) file,ICD-9-CM code with decimal – billable only (txt) file, and CPT-4/HCPCS code (txt) file.  These files are in a tab-delimited text file format for downloading and contain the same information as described above.  A fifth text file, providing the condition and treatment descriptions (txt) for each line item, is also available.
 
The corresponding Condition Index and Treatment Index by key word will be posted as soon as they are available.
 
If any discrepancies are found between either the ICD-9-CM or CPT-4/HCPCS files and the PDF file of the complete list, please emailto report them to us.
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The Prioritized List of Health Services that was effective 10/1/09 to 12/31/09 can be found here