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Pending Changes to Prioritized List
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Updated 11-14-11
January 1, 2012 Prioritized List of Health Services (pdf)
For your convenience, we have extracted out the lines including mental health & chemical services as well as dental services from the full list for those particularly interested in the placement of these condition-treatment pairs and their related guidelines.
Extracted Mental Health and Chemical Dependency Lines (pdf) (Coming soon)
Extracted Dental Lines (pdf)(Coming soon)
A new Prioritized List of Health Services will go into effect on January 1, 2012 that first appeared in the Health Services Commission's 2011 Report to the Governor and 75th Oregon Legislative Assembly The legislature has approved a funding level that covers services appearing on lines numbered 1 - 498 out of the 692 lines on this list; however, the state is still awaiting approval from the Centers for Medicare and Medicaid Services (CMS) for approval to implement at this level of coverage. Due primarily to the splitting of eight dental lines into twenty new lines, Line 511 on the January 1, 2012 List equates to the current funding line of 502 on the October 1, 2011 List.
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 1st 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 above 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, 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 for each line item, is also 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 email to report them to us.
Prioritized List of Health Services effective 10/1/11 - 12/31/11
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