MedicaidBilling CodesMedium impact
Fee-for-service billing guidance for OHP-covered falls prevention programs, effective April 1, 2026
Oregon Health Plan·OR · Geriatrics, Physical Therapy, Occupational Therapy +1 more·Provider
Effective date
Apr 1, 2026
We identified it
Jun 26, 2026
Summary
Oregon Health Authority has published new fee-for-service billing guidance for OHP-covered falls prevention programs effective April 1, 2026. The guidance specifies eligible services, billing requirements, covered procedure codes/modifiers, and reimbursement rates for OHP members 65+ and younger members with identified falls risk. For CCO-enrolled members, providers must contact the specific CCO directly as coverage and billing policies may differ.
Action Required
By March 31, 2026: Billing team must obtain and review the complete OHA billing guidance document for OHP-covered falls prevention programs (referenced but not included in this memorandum). Update billing system with the specific procedure codes, modifiers, and fee-for-service reimbursement rates once the full guidance is accessed. Establish workflow to distinguish between FFS (open card) OHP members and CCO-enrolled members—for FFS members, apply OHA billing guidance; for CCO members, contact the specific CCO for coverage and billing requirements. Communicate updated billing procedures to clinical staff. Failure to apply correct coding and rates will result in claim denials and payment delays.