MedicaidReimbursementMedium impact
2026 handicapping malocclusion risk corridor and fee-for-service rates
Oregon Health Plan·OR · Dentistry, Oral & Maxillofacial Surgery·Plan contract
Effective date
Jan 1, 2026
We identified it
Jun 20, 2026
Summary
Oregon Health Plan updated 2026 fee-for-service rates for handicapping malocclusion (orthodontic) treatment codes D8070-D8091, with priced encounters limited to 120% of FFS rates. All comprehensive orthodontic treatment requires prior authorization and must follow specific reimbursement requirements.
Action Required
By January 1, 2026: Billing team must update fee schedules for orthodontic codes D8070, D8080, D8090, and D8091 to new FFS rates ($2,982.06 for D8070, $4,203.64 for others). Ensure all comprehensive orthodontic treatment claims for CCO members include prior authorization. Update billing system to cap reimbursement at 120% of FFS rates and use lump sum payment model at beginning of each treatment phase per Oregon Administrative Rule 410-123-1260.