MedicaidPrior AuthHigh impact
CCO requirements for participation in the risk corridor settlement for OHP-covered handicapping malocclusion services
Oregon Health Plan·OR · Dentistry·Plan
Effective date
Jan 1, 2023
We identified it
Jun 20, 2026
Summary
Oregon requires CCOs to follow fee-for-service reimbursement and prior authorization requirements for orthodontic treatment of handicapping malocclusions starting January 1, 2023. All covered orthodontic codes must receive prior authorization using OHA's criteria, with payments following the FFS model and maximum reimbursement rates specified.
Action Required
By January 1, 2023: CCOs must implement prior authorization requirements for all orthodontic codes D8080, D8220, D8660, D8680, and D8695. Update billing systems to use OHA's billing codes and payment models consistent with FFS rules. Configure systems to enforce maximum reimbursement rates ($3,759 for D8080, $200 for D8220, $276 for D8660, $282.62 for D8680, $98.99 for D8695). Review draft Orthodontia Review Criteria and submit feedback to vesna.g.hopkins@dhsoha.state.or.us by November 18, 2022.