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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-130-0220-10152015Notice 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
NPRM-120-148-09172015Notice of Rulemaking Hearing
Update International Classification of Diseases Coding from ICD-9 to ICD-10
This is not a rulemaking hearing; however, the public comment period will end September 17, 2015, at 5 p.m.
You may submit comments to dmap.rules@state.or.us.
130-0220-05292015Temporary Rule Filing
410-130-0220 Table 130-0220-1
Update Table of Not Covered/Bundled Billing Codes to Bring Current with Coverage Policy
130-0160-04012015Permanent Rule Filing
Allow Use of Medical Billing Codes Designated for Adaptive Behavior Assessment and Treatment Services
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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

ICD-10 PA Update Form
Prior Authorization Handbook
Professional Billing Instructions
Medical-Surgical Services Provider Guide, 8-31-2015
Billing for Child Abuse Assessments and Related Services
OHP birth control methods and reimbursement
Oregon Medicaid reimbursement for doula services
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, 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
Oregon Medicaid PA Criteria, January 20151/1/2015
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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 - 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
Oregon Medicaid Preferred Drug List - January 1, 20151/1/2015
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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


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
June 2015 reprocessing of some fee-for-service physician-administered drug claims6/26/2015
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Who to call for help

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