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).
|Nprm-130-0240-111814||Notice 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.
|130-changes-100114||Temporary Rule Filing|
410-130-0200 and 410-130-0220
Remove Not Covered Status from Billing Codes for Sex Reassignment Surgery, Add Prior Authorization Requirement
|130-0200-070814||Permanent Rule Filing|
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.
|Nprm-130-0200-061714||Notice of Rulemaking Hearing|
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.
|Multiple-Programs-040414||Permanent Rule Filing|
Elimination of Oregon Health Plan Standard Benefit Plan Effective January 1, 2014
Supplemental information and guidelines
To learn more about National Drug Code (NDC) reporting, visit DMAP's NDC reporting page.
National Drug Code reporting
Oregon Medicaid PA Criteria
The Oregon Pharmacy Call Center uses these criteria when reviewing prior authorization requests for fee-for-service prescriptions.
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.
Prior Authorization for Out-of-State Services
Newborn Notification Form
Maternity Case Management - Initial Assessment
Maternity Case Management - Training and Education Tracking
Maternity Case Management - Home and Environmental Assessment
Maternity Case Management - Five A's Intervention Record (FAIR) for Smoking Cessation
Prior Authorization Request for Pharmacy and Oral Nutritional Supplements
Hysterectomy Consent - Spanish
Consent to Sterilization
Consent to Sterilization - Spanish
Ages 15-20 Consent to Sterilization
Ages 15-20 Consent to Sterilization - Spanish
Lead Risk Assessment Questionnaire
Who to call for help
Provider Services 800-336-6016 or email us
Address and telephone contacts