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 | D9120 D9310 D9920 D9211 D9993 view top 100 |
Description | description | text | Brief description of the service covered by the procedure code | local anesthesia occlusal adjustment-complete dental case management - care coordination application of desensitizing resin application of desensitizing med 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 Members over 18 years of age Covered for under age 21 only 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) | For each 15-minute period, up to three and a half hours on the same day of service Covered only when extracting a tooth connected to a fixed prosthesis and a portion of the fixed prosthesis is to remain intact and serviceable, preventing the need for more costly treatment Limits payment to oral medications used during a procedure and is not intended for "take home" medication. Only for urgent or emergent dental visits that occur outside of a dental office. This code is not reimbursable for provision of preventive services or for services provided outside of the office for the provider or facilities’ convenience. Limited to four time per year for clients under 13 years of age. Includes payment for monitoring and Nitrous Oxide. Requires use of multiple agents to receive payment. view top 100 |
Notes | notes | text | Lists additional notes regarding billing, documentation and deletions | Excluded file (e.g., travel vaccines) Only use general anesthesia or IV sedation for those clients with concurrent needs: age; physical, medical or mental status; or degree of difficulty of the procedure Bundled service Reimbursed per date of service, not by time Follow up care includes fitting, adjustments, modifications, and professional services in the first 90 days after provision of the oral appliance. 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 |