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Oregon Health PlanMedicaid · Coverage · Plan · ORHigh impact

Reimbursement for nitrous oxide during in-office medical procedures effective Aug. 1, 2026

Act
by Aug 1, 2026
Effective date
Aug 1, 2026
Identified
Aug 1, 2026

Summary

Effective August 1, 2026, Oregon Health Plan (OHP) now covers nitrous oxide for use during in-office medical procedures. Providers must bill using CPT code 01999 with modifier QS at a reimbursement rate of $44.08. CCOs must update claims processing systems to recognize and reimburse for this service.

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What to do

by Aug 1, 2026 · 6 steps
01Billing team must update billing software to enable claims submission for nitrous oxide using CPT code 01999 with modifier QS.
02Verify that the system recognizes the $44.08 reimbursement rate for OHP claims.
03Train providers and clinical staff on proper coding and documentation requirements for nitrous oxide administration during in-office procedures.
04For CCO-contracted providers: notify your contracted CCOs that claims processing systems must be configured to reimburse nitrous oxide for in-office medical procedures.
05Update encounter forms and billing checklists to include nitrous oxide as a billable service option.
06Claims submitted without the QS modifier or using incorrect codes may be denied or delayed.

Codes mentioned

01999

Original notice

Reimbursement for nitrous oxide during in-office medical procedures effective Aug. 1, 2026
oregon.gov · Always check the source before changing claims.
View original ↗

Related policy hubs

Oregon Health Plan policiesOR policy changesCode 01999

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