MedicaidCoverageMedium impact
Billing for covered fall prevention programs
Oregon Health Plan·OR · Family Medicine, Internal Medicine, Geriatrics +2 more·Provider
Effective date
Aug 16, 2022
We identified it
Jun 20, 2026
Summary
Oregon Health Plan (OHP) now covers evidence-based fall prevention programs for members 65+ and younger members with identified falls risk. Providers can bill using specific CPT/HCPCS codes with diagnosis code Z91.81 for covered programs like Tai Chi and exercise classes.
Action Required
Immediately: Billing team must update system to allow billing for fall prevention programs using diagnosis code Z91.81 and procedure codes CPT 98961, 98962, and HCPCS S9451. Add modifier GT or 95 for telehealth services. Bill member's CCO or OHA if not in CCO. Update encounter forms to include these codes for eligible OHP members.