This document pertains to services provided on or after January 1, 2020. Copyright Notice: Current Dental Terminology © 2020 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. "Not covered" codes are not part of the OHP Plus benefit package, or are for services that are incidental to another service and not reimbursed separately. Where applicable, please refer to Prioritized List placement, Guideline Notes and OARs listed for each code for complete information regarding benefit coverage and limitations. For services billed as medical, use the CMS-1500 claim format, CPT/HCPCS codes and ICD-10-CM diagnosis codes. (This list may not note every dental code that has a corresponding medical code.) To find fee-for-service reimbursement rates, view the OHP Fee-for-Service Fee Schedule at http://www.oregon.gov/oha/hsd/ohp/pages/fee-schedule.aspx. This schedule represents a given point in time and may not include payable codes that were added to MMIS after the posted fee schedule date.
This dataset has the following 11 columns:
Column Name | API Column Name | Data Type | Description | Sample Values |
---|---|---|---|---|
Code | code | text | Procedure code | D7981 D7210 D7920 D7111 D7140 view top 100 |
Description | description | text | Brief description of the service covered by the procedure code | excision of salivary gland surgical removal-erupted tooth oroantral fistula closure extraction-erupted tooth or exposed root extraction-coronal remnants, deciduous tooth view top 100 |
OHP Plus Benefit Coverage | ohp_plus_benefit_coverage | text | Indicates whether the code is covered for all members, specific benefit groups (e.g., under age 21), or not covered under the OHP Plus benefit package | Not covered All members Covered for under age 21 only Covered for members under age 21 and pregnant adults view top 100 |
Prioritized List Placement | prioritized_list_placement | url | If applicable, provides the procedure's line placement on the Prioritized List of Health Services, with a link to guidance for that line | view top 100 |
Guideline Note 1 | guideline_note_1 | url | If applicable, provides the Guideline Note associated with the code's Prioritized List placement, with a link to guidance for that line | view top 100 |
Guideline Note 2 | guideline_note_2 | url | If applicable, provides additional Guideline Note associated with the code's Prioritized List placement, with a link to guidance for that line | view top 100 |
Guideline Note 3 | guideline_note_3 | url | If applicable, provides additional Guideline Note associated with the code's Prioritized List placement, with a link to guidance for that line | view top 100 |
OAR 1 | oar | url | If applicable, provides a link to Dental Services OAR that lists specific limitations for the code | view top 100 |
Limitations | limitations | text | Coverage limitations for this code (such as age or annual benefit limits) | The Division limits payment for surgical removal of impacted teeth or removal of residual tooth roots to treatment for only those teeth that have acute infection or abscess, severe tooth pain, or unusual swelling of the face or gums Not to be paid seperately Covered once per lifetime per arch when the client has ankyloglossia; when the condition is deemed to cause gingival recession; or when the condition is deemed to cause movement of the gingival margin when the frenum is placed under tension. Removal of dental implants included only when there is advanced per-implantitis with bone loss and mobility, abscess or implant fracture. view top 100 |
Notes | notes | text | Lists additional notes regarding billing, documentation and deletions | Excluded file (e.g., travel vaccines) Removal of device is part of the surgery and not billable as a separate service Ancillary Deleted by ADA in 2021 view top 100 |
File Date | file_date | calendar_date | The effective date of the file | 2022-01-01T00:00:00.000 2021-01-01T00:00:00.000 view top 100 |