MedicaidBilling CodesMedium impact
Billing for covered fall prevention programs with updated telehealth billing requirements
Oregon Health Plan·OR · Family Medicine, Internal Medicine, Geriatrics +1 more·Plan
Effective date
Sep 20, 2023
We identified it
Jun 20, 2026
Summary
Oregon Health Plan (OHP) providers can now bill for evidence-based fall prevention programs for members 65+ or those with falls risk using specific CPT/HCPCS codes. New telehealth billing requirements effective September 20, 2023 require modifier 95 and specific Place of Service codes based on member location.
Action Required
Immediately: Billing team must update system to bill fall prevention programs using diagnosis code Z91.81 and CPT codes 98961, 98962, or HCPCS S9451. For telehealth services, add modifier 95 and use Place of Service code 02 (non-home) or 10 (home). Bill member's CCO or OHA if not in CCO. Update encounter forms for providers treating OHP members 65+ or those with falls risk.