Quarterly updates of the maximum allowable payment rates that apply to services directly billed to OHA, in compliance with applicable law.
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Fee schedule files
The Medical-Dental fee schedules are informational only. Because many factors influence payment, inclusion of a rate in the fee schedule does not guarantee payment. Files are usually posted by March 1, June 1, Sept 1 and Dec 1. They reflect information available in the month posted, and do not reflect fees for all programs. Rates may change without notice. Only codes with rate changes in the month posted will show a new effective date.
The Behavioral Health (Mental Health and Substance Use Disorder) fee schedules list the procedure codes and payment amounts effective for services provided on or after on and after the fee schedule date. Files are usually posted in January, April, July and October.
This list shows the most recent files available. Use the search function to view older files.
- For program-specific rates not listed in the OHP fee schedule and any program-specific payment policies that may apply: Refer to your provider guidelines, rules or contracts.
- For billing, service coverage, accepted codes and fee-for-service payment policies: See the OHP Billing Tips, General Rules, and OHP Administrative Rules.
- For prior authorization, procedure-specific coverage for an OHP client or benefit plan, or Prioritized List of Health Services coverage: Use the Benefits and HSC List Inquiry search on the secure Provider Web Portal.