Skip to main content

Oregon State Flag An official website of the State of Oregon »

Oregon.gov Homepage

Prioritized List of Health Services

Overview

The Prioritized List is only one part of determining if the Oregon Health Plan covers a service.

  • OHP routinely covers diagnostic and ancillary services.
  • OHP may decide to cover other services based on policy or individual review.
  • OHP covers all medically necessary and medically appropriate services for members under age 21. To learn more, visit OHA's EPSDT page.

Questions and Answers about the Prioritized List

For detailed information about the creation of the Prioritized List, see the Health Evidence Review Commission's (HERC) Brief History of Health Services Prioritization in Oregon or the biennial reports to the Oregon Legislature on the HERC reports page.

The Oregon Health Evidence Review Commission (HERC) ranks health care condition and treatment pairs in order of clinical effectiveness and cost-effectiveness.

The Prioritized List emphasizes prevention and patient education. In general:

  • Treatments that help prevent illness are ranked higher than services that treat illness after it occurs.
  • OHP covers treatments that are ranked on a covered Prioritized List line for the client's reported medical condition.

Effective Jan. 1, 2022, OHP covers Prioritized List lines 1 through 472.

Effective Jan. 1, 2023, OHP covers all medically necessary and medically appropriate services for members under age 21. This is true even if the services are below line 472. To learn more, visit OHA's EPSDT page​. 

Use the following links on the HERC website. You can also subscribe to receive email notifications from HERC. HERC sends updates whenever Prioritized List information changes.

For OHA policies related to Prioritized List coverage or exclusions, see the General Rules, Oregon Health Plan rules, and the provider guidelines specific to your program.

To find out whether a specific procedure is potentially covered according to the Prioritized List, providers can:

  • Use the HSC List inquiry on the Oregon Medicaid Provider Portal at www.or-medicaid.gov. This inquiry can tell you the specific line placement for the treatment/condition pair; or 
  • Call the OHP Code Pairing and Prioritized List Hotline at 800-336-6016. ​
The list prioritizes treatment (procedure code) and condition (diagnosis code) pairs. To use the Prioritized List, you need to know :
  • The treatment you want to know about, and
  • The condition it would treat.

OHP covers all medically necessary and medically appropriate services for OHP members under age 21. To learn more, visit OHA's ESPDT page​.​

Recent Prioritized List Updates

For more information about the Prioritized List, visit the Health Evidence Review Committee's Prioritized List of Health Services page.

 Subscribe to receive updates from HERC when they occur.