MedicaidReimbursementHigh impact
Request for Comment - State Plan Amendment to increase fee-for-service SUD rates
Oregon Health Plan·OR · Psychiatry·Public notice
Effective date
Oct 1, 2019
We identified it
Aug 19, 2026
Summary
Oregon Medicaid is implementing a State Plan Amendment effective October 1, 2019, increasing fee-for-service reimbursement rates for substance use disorder (SUD) treatment and mental health services. SUD codes receive increases ranging from 10-38%, while mental health codes receive a 4% increase. Billing teams must update fee schedules in their systems to reflect new rates for all affected CPT/HCPCS codes.
Action Required
By October 1, 2019: Billing team must immediately update all fee schedules in the billing software to reflect new Oregon Medicaid rates for the 34 affected SUD and mental health CPT/HCPCS codes listed above. Update rates for H0001-H0048, T1006 (SUD codes with increases of 10-38%) and 90785-96130 (mental health codes with 4% increases). Verify that claims submitted on or after October 1, 2019 use the new rates. Obtain the complete updated fee schedule from https://www.oregon.gov/oha/HSD/OHP/Pages/Fee-Schedule.aspx. Failure to update rates will result in underbilling and revenue loss for Oregon Medicaid claims.