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Medical-Surgical Services Program


Oregon Administrative Rules and supplemental information administered by the Health Systems Division.

 Receive program updates by text or email - Please specify which program(s) you are interested in; otherwise, you will receive updates for all programs.

Current Oregon Administrative Rules

Please refer to the Oregon Secretary of State website. OHA no longer maintains the administrative rulebooks.

  • Click the program name, then click the rule you want to view.
  • The current rule will display. To view previous revisions of the rule, click the revision date(s) at the bottom of the rule page. Revisions are available back to 2017.
  • If you need older revisions, please email Adminrules.Archives@oregon.gov.
  • If you have problems accessing older revisions not available on the SOS website, please email HSD.Rules@dhsoha.state.or.us

Recent rule filings

Supplemental information and guidelines

Oregon Medicaid PA Criteria

The Oregon Pharmacy Call Center uses these criteria when reviewing prior authorization (PA) requests for fee-for-service prescriptions.

Preferred Drug List

Physical health drugs on this list do not require PA. Lists before 2012 are in Oregon Administrative Rule 410-121-0030 (Tables 410-121-0030-1 and 410-121-0030-2). You can also use the Searchable PDL.

Forms

Announcements

Policy Quick Links

Rules and Guidelines by Program

Temporary Rule Filings

Permanent Rule Filings

Notices of Proposed Rulemaking

Medical-Surgical Quick Links

Prioritized List of Health Services

Medicare Physician Fee Schedule

NDC reporting for physician-administered drugs

Code groups

Group 1118 (referenced in OAR 410-130-0220)

Group 1119 - Diagnostic Procedure Codes

Group 6030 - Undefined Diagnosis Codes

Group 6031 - Conditions Not Covered

Group 6032- Diagnostic Workup File

Group 6033 - Informational Diagnosis Codes

Group 6060 - Ancillary Services

Out of hospital births

Reimbursement Guide 

Vaccines

Vaccines for Children Program

State Supplied Vaccine Codes - To bill for the $21.96 administration fee, you must use modifier SL with the vaccine-specific CPT code.

Who to call for help

Provider Services

For services to patients not enrolled in a coordinated care organization for physical health care:

 800-336-6016 or  email us

 Address and telephone contacts


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