Current Prioritized List of Health Services
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|Current Prioritized List (4/1/13 to 3/30/13)|
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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.
A new Prioritized List of Health
Services went into effect on January 1, 2012 that first appeared in the former
Health Services Commission's 2011 Report to the Governor and 76th Oregon Legislative
Assembly. The legislature approved a funding level that covers services
appearing on lines numbered 1 - 498 out of the 692 lines on this list and the
Centers for Medicare and Medicaid Services (CMS) have approved implementation of
this coverage reduction of 13 lines. Due primarily to the
splitting of eight dental lines into twenty new lines, Line 498 on the January
1, 2012 List equates to line 488 on the October 1, 2011 List.
code (pdf) file and a CPT-4/HCPCS code (pdf) file are available to view the
placement of individual codes on the October 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.”
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.
This notice to the Senate President
dated February 13, 2013, identifies the second set of interim modifications made
to the 2012-13 Prioritized List of Health Services appearing in Appendix C of
the Commission’s June
2011 Biennial Report. These interim modifications go into
effect on April 1, 2013.
Retraction of Changes to Elective Induction of Labor Guideline
(pdf)This letter dated March 21, 2013 gives notice to legislative leadership
that the approved changes to the Prioritized List’s guideline on the elective
induction of labor will not be implemented on April 1, 2013 as previously
indicated in the 2/13/13 letter pending a further review of the evidence and
provider concerns that may result in changes to the Commission’s coverage
guidance on this topic that underlays the Prioritized List guideline