MedicaidAdministrativeHigh impact
Billing for abortions, miscarriage management and complications following an abortion
Oregon Health Plan·OR · OB-GYN, Family Medicine, Emergency Medicine·Plan
Effective date
Nov 21, 2024
We identified it
Jun 20, 2026
Summary
Oregon Health Plan has updated billing procedures for reproductive health services. All abortion codes must be billed to Oregon Health Authority (OHA) regardless of member type, while miscarriage management and post-abortion complications follow different billing rules based on whether the member is in a CCO or fee-for-service plan.
Action Required
Immediately: Billing team must update billing workflows to route all abortion-related codes to Oregon Health Authority (OHA) for all Oregon Health Plan members. For miscarriage management codes, bill CCO for CCO members and OHA for fee-for-service members. For post-abortion complications outside global surgical timeframe, bill CCO for CCO members and OHA for fee-for-service members. When uncertain if service is abortion or miscarriage, default to billing as abortion to OHA. Update billing system rules and staff training accordingly.