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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-130-0200-12152015Notice of Rulemaking Hearing
Begin to Require Prior Authorization for Payment of Gender Dysphoria Surgeries, OHP-FFS Program
Rulemaking Hearing: December 15, 2015 at 10:30 a.m. in Room 137C
Last Opportuity for Public Comment: December 17, 2015 at 5 p.m.
Send Comments: dmap.rules@state.or.us
Nprm-130-0200-OOH-12152015Notice of Rulemaking Hearing
OHP FFS Program, Begin Requiring Prior Authorization for Billing Out-of-Hospital Birth Services
Rulemaking Hearing: December 15, 2015 at 10:30 a.m. in Room 137C
Last opportunity for public comments: December 17, 2015 at 5 p.m.
Send comments to dmap.rules@state.or.us.
130-0220-11012015Permanent Rule Filing
Revision to List of Medical Billing Codes Excluded from Payment under OHP's FFS Program
Nprm-130-0220-10152015Notice of Rulemaking Hearing
Revision to List of Medical Billing Codes Excluded from Payment under OHP's FFS Program
Rulemaking Hearing: October 15, 2015 at 10:30 a.m. in Room 165
Last opportunity for public comment: October 17, 2015 by 5 p.m.
Send comments to: dmap.rules@state.or.us
120-148-changes-10012015Permanent Rule Filing
410-120 to 410-148
Update International Classification of Diseases Coding from ICD-9 to ICD-10
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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. For vaccine codes covered under the Vaccines for Children (VFC) program, see State Supplied Vaccine Codes (use Modifier SL or 26 to receive $21.96 VFC administration fee).

Provider guides

Oregon Medicaid reimbursement for doula services
ICD-10 PA Update Form
Billing for Child Abuse Assessments and Related Services
Prior Authorization Handbook
Professional Billing Instructions
Medical-Surgical Services Provider Guide, 8-31-2015
OHP birth control methods and reimbursement
Claim Adjustment Handbook

National Drug Code reporting

Codes Requiring NDC Information (Procedure Group 6069)
National Drug Code reporting tips
National Drug Code reporting webinar
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 201510/9/2015
Oregon Medicaid PA Criteria, August 20158/25/2015
Oregon Medicaid PA Criteria, July 20157/1/2015
Oregon Medicaid PA Criteria, April 20154/18/2015
Oregon Medicaid PA Criteria, February 20152/3/2015
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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 - November 1, 201511/1/2015
Oregon Medicaid Preferred Drug List - October 1, 201510/1/2015
Oregon Medicaid Preferred Drug List - July 1, 20157/1/2015
Oregon Medicaid Preferred Drug List - April 18, 20154/18/2015
Oregon Medicaid Preferred Drug List - March 1, 20153/1/2015
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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​

MSC 3971
DHS/OHA Prior Authorization Request - instructions


Planned out-of-hospital births will require prior authorization starting December 1, 201511/18/2015
Fee-for-service professional claim reprocessing scheduled for September 26, 20159/24/2015
September 4 reprocessing of some fee-for-service physician-administered drug claims9/4/2015
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Who to call for help

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