MedicaidReimbursementHigh impact
Public notice - State Plan Amendment to expand Medicaid coverage of telehealth services
Oregon Health Plan·OR·Public notice
Effective date
Jan 1, 2020
We identified it
Aug 19, 2026
Summary
Oregon Medicaid is expanding coverage of telehealth and telephone services retroactively effective January 1, 2020, with significantly increased reimbursement rates for three telehealth CPT codes (99441, 99442, 99443). Rates are increasing 60-85% to match in-person service payments. Billing teams must update fee schedules and system rates immediately to capture retroactive claims and ensure accurate billing going forward.
Action Required
IMMEDIATELY (by March 31, 2020 for SPA submission deadline): Billing team must update Oregon Medicaid fee schedules in billing system with new reimbursement rates for telehealth codes: CPT 99441 from $9.86 to $16.04, CPT 99442 from $19.16 to $31.44, and CPT 99443 from $28.12 to $51.97. Apply retroactive rate changes to all Oregon Medicaid claims dated January 1, 2020 forward. Audit any denied or underpaid claims from January-March 2020 for these codes and resubmit with corrected rates. Notify providers that telehealth and telephone services are now covered under expanded HERC guidelines (synchronous audio/video, phone, online portal, provider-to-provider consultations). Update encounter templates to capture telehealth service modality for accurate coding. Failure to implement rate changes will result in underpayment on all future Oregon Medicaid telehealth claims.