MedicaidBilling CodesHigh impact
Billing guidance for obstetric services provided by FQHCs and RHCs
Oregon Health Plan·OR · OB-GYN·Plan contract
Effective date
Apr 21, 2026
We identified it
Aug 19, 2026
Summary
Oregon Health Authority requires FQHCs and RHCs to bill individual obstetric visit codes (0500F, 0502F, 0503F) to CCOs when providing care under global/bundled OB procedure codes, effective April 21, 2026. These codes must be paid at $0.00 and included in encounter data to enable OHA to issue supplemental wraparound payments. Retroactive billing for services from October 1, 2024 through April 20, 2026 is also permitted.
Action Required
By April 21, 2026: Billing team must update system to add codes 0500F (initial prenatal), 0502F (subsequent prenatal), and 0503F (postpartum) to all obstetric claims billed to CCOs when submitted under global codes 59400, 59425, 59426, 59410, or 59430. Configure system to bill these encounter codes at $0.00 reimbursement. Providers must append these codes to obstetric claims for services on or after April 21, 2026. For retroactive claims (Oct 1, 2024 - April 20, 2026): Billing team should submit 0500F, 0502F, or 0503F codes for any prior dates of service where not previously billed to enable OHA wraparound payment processing. Coordinate with CCO to ensure old claims are accepted and coded at $0.00. Failure to report encounter data correctly will prevent OHA from issuing supplemental wraparound payments and create payment discrepancies. Contact Adrienne Cooke at 503-551-0630 or Adrienne.Cooke@oha.oregon.gov with questions.