Oregon Medicaid Orthodontic Codes

This document pertains to services provided on or after January 1, 2020. Copyright Notice: Current Dental Terminology © 2020 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.

"Not covered" codes are not part of the OHP Plus benefit package, or are for services that are incidental to another service and not reimbursed separately. Where applicable, please refer to Prioritized List placement, Guideline Notes and OARs listed for each code for complete information regarding benefit coverage and limitations.

For services billed as medical, use the CMS-1500 claim format, CPT/HCPCS codes and ICD-10-CM diagnosis codes. (This list may not note every dental code that has a corresponding medical code.)

To find fee-for-service reimbursement rates, view the OHP Fee-for-Service Fee Schedule at http://www.oregon.gov/oha/hsd/ohp/pages/fee-schedule.aspx. This schedule represents a given point in time and may not include payable codes that were added to MMIS after the posted fee schedule date.

本文件涉及自2020年1月1日起提供的服务。版权声明：当前牙科术语©2020美国牙科协会。版权所有。适用联邦收购法规/国防联邦收购法规。

“不予报销”代码不属于OHP Plus福利套餐的范畴，或是指附带于其他服务但未单独报销的服务。如有适用，请参阅每个代码的优先级列表、指南注释和OARs，以获取关于福利覆盖范围和限制的完整信息。

对于作为医疗服务计费的服务，请使用CMS-1500索赔格式、CPT/HCPCS代码和ICD-10-CM诊断代码。（此列表可能未列出所有对应医疗代码的牙科代码。）

要查找按服务收费的报销率，请查阅OHP按服务收费费用表，访问http://www.oregon.gov/oha/hsd/ohp/pages/fee-schedule.aspx。此费用表代表某一特定时间点，可能未包括在公布费用表日期之后添加到MMIS的可报销代码。