MedicaidReimbursementHigh impact
Provider Announcement
Oregon Health Plan·OR · Emergency Medicine·Plan
Effective date
Mar 18, 2020
We identified it
Jun 20, 2026
Summary
Oregon Health Authority is increasing reimbursement rates for ambulance "Treat in Place" services from $54.45 (A0998) to $420.62 (A0427 ALS1 Base Rate) for Oregon Health Plan fee-for-service members during the COVID-19 emergency, retroactive to March 18, 2020. Additionally, ambulances may now provide non-emergent transportation for COVID-19 positive or presumptive positive patients to primary/urgent care facilities.
Action Required
REQUIREMENTS: Immediately update billing system and ambulance provider contracts to reflect the new reimbursement rate of $420.62 for procedure code A0427 (replacing A0998 at $54.45) for all Oregon Health Plan fee-for-service "Treat in Place" calls. Billing team must: (1) Reprocess or request adjustment of all ambulance claims for OHP fee-for-service members from March 18, 2020 forward using the increased A0427 rate; (2) Update internal billing documentation and provider guidance to reflect the rate change; (3) Train ambulance billing staff on new coding requirements; (4) Coordinate with Coordinated Care Organizations (CCOs) to ensure they increase A0998 reimbursement to A0427 base rate as directed by OHA. For dual Medicare/Medicaid beneficiaries, continue billing Medicare first with Medicaid as secondary per existing coordination of benefits rules. Contact Mary Durrant (mary.durrant@dhsoha.state.or.us, 503-947-2634) with questions. Failure to update billing may result in underpayment of claims or payment denials.