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.

Recent rule filings

You can also view all Medical-Surgical Services Program rules as filed with the Secretary of State.

Administrative rulebooks

Each rulebook is an interactive PDF that contains all program rules effective on the "Effective Date" listed for the rulebook. If you need an older rulebook not listed here visit the OHP Rulebooks page.

Supplemental information and guidelines

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. Lists before 2012 are in the Pharmeceutical Services administrative rulebooks.

Forms

Policy Quick Links

Rule and guidelines by program

Temporary rules

Notices of Proposed Rulemaking

OHP Rulebooks

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

OAR 333-076-0650 risk factor tables:

Table 1 - Absolute risk factors that would prohibit admission to a birthing center for labor and delivery
Table 2 - Intrapartum risk factors that would require transfer to a higher level of care
Table 3 - Mother and infant postpartum risk factors that would require transfer to a higher level of care

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