MedicaidAdministrativeMedium impact
Billing for peer delivered services
Oregon Health Plan·OR · Psychiatry, General Practice·Plan
Effective date
May 12, 2025
We identified it
Aug 19, 2026
Summary
Oregon Health Authority has issued new billing guidance for peer-delivered services in non-Certificate of Approval (COA) provider settings. Billing teams must ensure claims processing systems are configured to accept peer-delivered service claims when members have covered health conditions matching Prioritized List procedure codes, services are within provider scope, and supervision requirements are met. All Traditional Healthcare Workers (including Peer Support Specialists and Peer Wellness Specialists) can deliver these services in non-COA settings.
Action Required
By May 31, 2025: Billing team must coordinate with IT/systems department to configure claims processing systems to accept peer-delivered service claims from non-COA provider settings. Verify that system validation rules allow billing codes for peer-delivered services when accompanied by covered health conditions from the Oregon Health Authority's Prioritized List of Health Services. Providers must be notified (by compliance or provider relations) about which provider settings are classified as non-COA and therefore eligible to bill peer-delivered services. Obtain the current Prioritized List of Health Services from OHA to identify which procedure codes pair with covered conditions. Failure to configure systems properly will result in claim denials or rejections for peer-delivered services.