MedicaidReimbursementMedium impact
Fee-for-service rates for enteral formula, effective Sept. 1, 2025
Oregon Health Plan·OR · Gastroenterology·Provider
Effective date
Sep 1, 2025
We identified it
Jun 20, 2026
Summary
Oregon Health Authority changed enteral formula billing rates effective September 1, 2025. Three specific codes (B4149, B4157, B4162) will be reimbursed at acquisition cost plus 25%, while all other enteral formula codes will use published fee schedule rates.
Action Required
Immediately: Billing team must update system to bill codes B4149, B4157, and B4162 at acquisition cost plus 25% for dates of service September 1, 2025 and after. Include manufacturer cost invoice and client prescription with each claim. Bill all other enteral formula codes using September 2025 Medical-Dental Fee Schedule rates. For retroactive claims April 1-August 31, 2025, bill all enteral formula codes at acquisition cost plus 25%.