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
Oct 6, 2026
Summary
Oregon Health Plan (OHP) establishes 2026 fee-for-service (FFS) rates and risk corridor limits for handicapping malocclusion (HM) comprehensive orthodontic treatment effective January 1, 2026. CCO providers must use four specific billing codes, obtain prior authorization per HM Benefit Guidance, and limit priced encounters to 120% of stated FFS rates. Claims must follow OHA's FFS reimbursement model and HLD Index California Modification Scoring Form criteria.
Action Required
Effective January 1, 2026: Billing team must implement the following changes for all CCO member orthodontic treatment claims: (1) Update billing system to use only the four specified codes (D8070, D8080, D8090, D8091) for HM comprehensive treatment; (2) Configure system to enforce 120% rate cap on priced encounters based on published FFS rates ($2,982.06 for D8070; $4,203.64 for D8080, D8091, D8091); (3) Implement mandatory prior authorization workflow per OHA's HM Benefit Guidance and HLD Index California Modification Scoring Form before adjudicating claims; (4) Configure payment model to align with FFS requirements in Oregon Administrative Rule 410-123-1260, including lump-sum payment option at the beginning of each treatment phase; (5) Verify system rejects claims exceeding the 120% reimbursement limit. Without these changes, claims will not qualify for the HM risk corridor and may be denied. Contact your CCO Account Representative or Medicaid Programs with questions.