MedicaidAdministrativeHigh impact
Providers should bill Oregon Health Authority for abortion services and CCOs for miscarriage management
Oregon Health Plan·OR · OB-GYN, Family Medicine, Emergency Medicine·Plan
Effective date
May 16, 2023
We identified it
Jun 20, 2026
Summary
Oregon providers must now bill Oregon Health Authority (OHA) directly for abortion services using modifier U4, while billing CCOs for miscarriage management services. This creates a clear billing pathway distinction between abortion services (to OHA) and miscarriage/complication management (to CCOs).
Action Required
Immediately: Billing team must update Oregon Medicaid billing protocols to bill OHA directly for abortion services (CPT 59841, 59840, HCPCS S0199) with modifier U4, and bill member's CCO for miscarriage management services (CPT 59820, 59821, 59812). Update billing system rules and staff training. For unclear services, use modifier U4 and bill OHA.