MedicaidReimbursementHigh impact
2026 handicapping malocclusion risk corridor and fee-for-service rates
Oregon Health Plan·OR · Dentistry, Oral & Maxillofacial Surgery·Plan contract
Effective date
Jan 1, 2026
We identified it
Aug 19, 2026
Summary
Oregon Health Plan (OHP) has established 2026 fee-for-service rates and reimbursement limits for handicapping malocclusion (HM) orthodontic treatment effective January 1, 2026. CCO providers must use specific billing codes, obtain prior authorization per HM Benefit Guidance, and limit payments to 120% of the published FFS rates. Claims must follow OHA's FFS reimbursement model and HLD Index scoring requirements.
Action Required
By January 1, 2026: Billing team must (1) update billing system to recognize and properly adjudicate dental codes D8070, D8080, D8090, and D8091 with the new 2026 FFS rates listed in the policy; (2) implement payment cap logic to limit reimbursement to 120% of FFS rates ($3,578.47 max for D8070; $5,044.37 max for D8080, D8090, D8091); (3) configure system to require prior authorization for all comprehensive orthodontic HM treatment before claim submission, using OHA's HM Benefit Guidance and HLD Index California Modification Scoring Form; (4) establish payment model to reimburse in lump sums by treatment phase consistent with OAR 410-123-1260 FFS model; (5) train billing staff and providers on new requirements. Update encounter forms and prior auth workflows to reflect requirements. Providers must document HM treatment phases and obtain PA decisions consistent with HLD Index scoring. Failure to obtain prior authorization or billing above the 120% cap will result in claim denials.