MedicaidCoverageMedium impact
Provider Announcement
Oregon Health Plan·OR·Provider
Effective date
Mar 23, 2020
We identified it
Jun 20, 2026
Summary
Oregon Health Authority (OHA) expanded telemedicine coverage for IHS/Tribal providers, FQHCs, and RHCs under Oregon Medicaid (OHP). Synchronous audiovisual telemedicine encounters and telephone encounters for evaluation/management, assessment/management, and psychotherapy services are now reimbursable at the clinic's PPS/IHS encounter rate during infectious disease epidemics. These services are eligible for wrap-around payment when not excluded from PPS or IHS MOU.
Action Required
By April 15, 2020: Billing team must review HERC Ancillary Guideline A5 (Telehealth, Teleconsultations and Electronic/Telephonic Services) to identify applicable telemedicine billing codes and ensure billing system is configured to reimburse telemedicine encounters at the clinic's PPS/IHS encounter rate. Verify that telemedicine claims are submitted with appropriate modifiers per OAR 410-130-0610. Providers must ensure all telemedicine encounters (audiovisual synchronous and telephone) are documented as meeting the expanded definition of face-to-face encounters. Contact Jennifer R. Smith (Jennifer.R.Smith@dhsoha.state.or.us, 503-509-5214) for FQHCs/RHCs or Jason Stiener (Jason.Stiener@dhsoha.state.or.us, 503-421-4079) for IHS/Tribal providers with questions. Failure to properly code and document telemedicine services may result in claim denials or non-compliance with OHP requirements.