MedicaidCoverageMedium impact
Provider Announcement
Oregon Health Plan·OR · Psychiatry, Pediatrics·Plan
Effective date
Feb 21, 2020
We identified it
Jun 20, 2026
Summary
Oregon Health Plan now explicitly covers specific ICD-10 diagnosis codes (Z69.010, Z69.020, Z62.820, Z63.8, F43.8) as primary diagnoses for behavioral health treatment of trauma, abuse, neglect, and relational problems in children. Billing teams must accept and process claims with these diagnoses paired with appropriate behavioral health treatment codes without denial.
Action Required
Immediately: Billing team must update claim processing rules in billing software to accept Z69.010, Z69.020, Z62.820, Z63.8, and F43.8 as valid primary diagnoses for behavioral health treatment claims on Oregon Health Plan. Remove any existing denial rules or edits that reject these codes as primary diagnoses. Train billing staff to process claims with these diagnoses without manual review or denial. Communicate to providers that claims with these trauma and relational diagnoses paired with behavioral health treatment codes will be accepted. Failure to update systems may result in inappropriate claim denials and revenue loss.