MedicaidCoverageMedium impact
Fee-for-service coverage of directly observed therapy, effective Oct. 1, 2024
Oregon Health Plan·OR · Infectious Disease, Pulmonology, Family Medicine +1 more·Provider
Effective date
Oct 1, 2024
We identified it
Jun 20, 2026
Summary
Effective October 1, 2024, Oregon Health Plan now covers directly observed therapy (DOT) for tuberculosis treatment using procedure code H0033, with reimbursement rates of $82 for in-person encounters and $20 for video/telehealth encounters. Claims must include valid TB-related diagnoses and telehealth modifiers when appropriate.
Action Required
Immediately: Billing team must update system to bill procedure code H0033 for directly observed therapy encounters (up to 2 per day). Ensure all claims include valid TB-related diagnosis from Line 50 of Oregon's Prioritized List. For video/telehealth DOT, add modifier 95 or GT to claims. Set reimbursement expectations at $82 for in-person DOT and $20 for video DOT.