MedicaidCoverageMedium impact
Provider Announcement
Oregon Health Plan·OR · Psychiatry, Pediatrics·Plan
Effective date
Jan 1, 2020
We identified it
Jun 20, 2026
Summary
Starting January 1, 2020, youth with a primary diagnosis of Autism Spectrum Disorder (ASD) became newly eligible for Wraparound services under procedure codes H2021 and H2022. This eligibility was previously missed during Oregon's 2014 Wraparound implementation and has now been officially paired by the Health Evidence Review Commission.
Action Required
By January 1, 2020 (retroactive): Billing team must update the billing system to recognize ASD (ICD-10 code F84.0 and related autism spectrum codes) as an eligible primary diagnosis for Wraparound services billed under H2021 (per 15 minutes) and H2022 (per diem). Update claim submission rules to allow ASD diagnoses with these HCPCS codes. Notify providers and Wraparound Review Committees of the new eligibility. Retroactively review any denied ASD Wraparound claims from January 1, 2020 forward and resubmit for payment consideration. Failure to implement this change will result in claim denials for eligible ASD youth.