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Oregon Health Policy and Research

Current Prioritized List of Health Services
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Current Prioritized List (4/1/13 to 9/30/13)

 

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Updated: 6/10/13

Errata


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.

 

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.

 
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 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.”
 
Also available are an ICD-9-CM code without decimal (txt, billable codes only) file ICD-9-CM code with decimal (txt, billable codes only) 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.
 
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.