MedicaidCoverageMedium impact
Billing for peer delivered services
Oregon Health Plan·OR · General Practice, Psychiatry·Plan
Effective date
May 12, 2025
We identified it
Jun 20, 2026
Summary
Oregon Medicaid has expanded billing eligibility for peer delivered services to include all Traditional Healthcare Workers (including Peer Support and Peer Wellness Specialists) in provider settings that don't require a Certificate of Approval. CCOs must configure their claims processing systems to accept these claims and notify providers of the expanded billing opportunities.
Action Required
Immediately: CCOs must configure claims processing systems to accept peer delivered services claims from non-COA provider settings. Notify all providers about expanded billing opportunities for Traditional Healthcare Workers providing peer services. Verify member has covered health condition that pairs with appropriate procedure code on Oregon's Prioritized List of Health Services before billing.