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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
Nprm-130-0200-0220-021715Notice of Rulemaking Hearing
410-130-0200 and 410-130-0220
Remove Not Covered Status from Billing Codes and Add Prior Authorization Requirement
Rulemaking Hearing: February 17, 2015 at 10:30 a.m., 500 Summer St. NE, Salem, OR 97301 Room 166
Last Opportunity for Public Comment: February 19, 2015 at 5 p.m.
Send Comments to: dmap.rules@state.or.us
130-0240-010115Permanent Rule Filing
Precluded Payment for Out-of-Hospital Birth in High Risk Pregnancies
130-0160-010115Temporary Rule Filing
Allow Use of Medical Billing Codes Designated for Adaptive Behavior Assessment and Treatment Services
130-0220-122414Temporary Rule Filing
Remove Artificial Disc Procedurs So Division May Reimburse Providers per Prioritized List of Health Services
Nprm-130-0240-111814Notice of Rulemaking Hearing
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.
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Administrative rulebooks

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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, January 20151/1/2015
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
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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 - January 1, 20151/1/2015
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
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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​


Consent to Sterilization​


Consent to Sterilization - Spanish​

Ages 15-20 Consent to Sterilization
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

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