Text Size:   A+ A- A   •   Text Only
Find     
Site Image

Medical-Surgical Services Program

Medical-Surgical Services Program

Oregon Administrative Rules and supplemental information administered by the Division of Medical Assistance Programs.

Recent rule filings

You can sort or filter by document type or effective date. You can also view Medical-Surgical Services Program rules as filed with the Secretary of State (please note that rules filed by the first of the month will not be posted on the Secretary of State website until the middle of the filing month).

  
  
File Description
  
130-0240-010115Permanent Rule Filing
410-130-0240
Precluded Payment for Out-of-Hospital Birth in High Risk Pregnancies
1/1/2015
Nprm-130-0240-111814Notice of Rulemaking Hearing
410-130-0240
Precluded Payment for Out-of-Hospital Birth in High Risk Pregnancies
Rulemaking Hearing: November 18, 2014 at 10:30 a.m., Room 137C
Last opportunity for public comment: November 20, 2014, by 5 p.m.
11/18/2014
130-changes-100114Temporary Rule Filing
410-130-0200 and 410-130-0220
Remove Not Covered Status from Billing Codes for Sex Reassignment Surgery, Add Prior Authorization Requirement
10/1/2014
130-0200-070814Permanent Rule Filing
410-130-0200
Revision to Fee-for-Service Medicaid rule; Additional Services Will Require Prior Authorization
This rule lists medical services by billing code for which the Division requires prior authorization (PA). It applies to Medicaid clients who are fee-for-service, i.e., not enrolled in a CCO. It includes a link to the required forms and directions. This revision adds language to specify when providers must obtain PA and outlines the criteria the Division uses to make authorization decisions. Additionally, this revision adds PA requirement to new groups of billing codes for tonsillectomy, cholecystectomy, and ear tubes, and it adds codes to several existing groups, such as bariatric surgery that already require PA.
7/8/2014
Nprm-130-0200-061714Notice of Rulemaking Hearing
410-130-0200
Revision to Fee-For-Service Medicaid rule; Additional Services Will Require Prior Authorization
Rulemaking Hearing: June 17, 2014, 10:30 a.m., Room 137B
Last Opportunity for Public Comment: June 20, 2014, by 5 p.m.
6/17/2014
1 - 5Next

Administrative rulebooks

​​
  
  
130rb10011410/1/2014
130rb0708147/8/2014
130rb0404144/4/2014
130rb0313143/13/2014
130rb0101141/1/2014
1 - 5Next

Supplemental information and guidelines

To learn more about National Drug Code (NDC) reporting, visit DMAP's NDC reporting page.

Provider guides

​​​
  
Claim Adjustment Handbook
Professional Billing Instructions
Medical-Surgical Services Provider Guide, 9-1-2012
Prior Authorization Handbook

National Drug Code reporting

  
National Drug Code reporting webinar
National Drug Code reporting tips
Codes Requiring NDC Information (Procedure Group 6069)
NCPDP Unit of Measure (UOM) List

Oregon Medicaid PA Criteria

The Oregon Pharmacy Call Center uses these criteria when reviewing prior authorization requests for fee-for-service prescriptions.

​​​
  
  
Oregon Medicaid PA Criteria, October 201410/14/2014
Oregon Medicaid PA Criteria, August 20148/13/2014
Oregon Medicaid PA Criteria, July 20147/15/2014
Oregon Medicaid PA Criteria, May 20145/1/2014
Oregon Medicaid PA Criteria, March 20143/17/2014
1 - 5Next

Preferred Drug List

Physical health drugs on this list do not require PA. Access the list using Epocrates Rx ('Oregon Medicaid - open card"), and access formularies for other payers, including OHP health plans. Lists before 2012 are in the Pharmeceutical Services administrative rulebooks.

​​​
  
  
Oregon Medicaid Preferred Drug List - October 29, 201410/29/2014
Oregon Medicaid Preferred Drug List - September 16, 20149/16/2014
Oregon Medicaid Preferred Drug List - July 15, 20147/15/2014
Oregon Medicaid Preferred Drug List - May 1, 20145/1/2014
Oregon Medicaid Preferred Drug List - March 21, 20143/21/2014
1 - 5Next

Forms

​​​​
  
Description
DHS 3971
Oregon DHS Prior Authorization Request - instructions
DMAP 1074

Prior Authorization for Out-of-State Services​

DMAP 2410

Newborn Notification Form​

DMAP 2470

Maternity Case Management - Initial Assessment​

DMAP 2471

Maternity Case Management - Training and Education Tracking​

DMAP 2472

Maternity Case Management - Home and Environmental Assessment​

DMAP 2473

Maternity Case Management - Five A's Intervention Record (FAIR) for Smoking Cessation​

DMAP 3978
Prior Authorization Request for Pharmacy and Oral Nutritional Supplements
DMAP 741

Hysterectomy Consent​

DMAP 741

Hysterectomy Consent - Spanish​

DMAP 742A

Consent to Sterilization​

DMAP 742A

Consent to Sterilization - Spanish​

DMAP 742B
Ages 15-20 Consent to Sterilization
DMAP 742B
Ages 15-20 Consent to Sterilization - Spanish
DMAP 9033

Lead Risk Assessment Questionnaire​


Who to call for help

Provider Services 800-336-6016 or email us
Address and telephone contacts

​​​ ​​​​​​​​​​​​​