1. (1) The Division Medical-Surgical Services rules are designed to assist medical-surgical providers to deliver medical services and prepare health claims for clients with Medical Assistance Program coverage. Providers must follow the Division rules in effect on the date of service.

2. (2) The Division enrolls only the following types of providers as performing providers under the Medical-Surgical program:

   1. (a) Doctors of medicine, osteopathy and naturopathy;
   2. (b) Podiatrists;
   3. (c) Acupuncturists;
   4. (d) Licensed Physician associates;
   5. (e) Nurse practitioners;
   6. (f) Laboratories;
   7. (g) Family planning clinics;
   8. (h) Social workers (for specified services only);
   9. (i) Licensed Direct entry midwives;
   10. (j) Portable x-ray providers;
   11. (k) Ambulatory surgical centers;
   12. (l) Chiropractors;
   13. (m) Licensed Dieticians (for specified service only);
   14. (n) Registered Nurse First Assistants;
   15. (o) Certified Nurse Anesthetists;
   16. (p) Clinical Pharmacists;
   17. (q) Birthing Centers;
   18. (r) Licensed Genetic Counselor.
3. (3) For clients enrolled in a managed care plan, contact the client's plan for coverage and billing information.
4. (4) The Medical-Surgical Services rules contain information on policy, special programs, prior authorization, and criteria for some procedures. All Division rules are intended to be used in conjunction with the General Rules for Oregon Medical Assistance Programs (OAR 410 division 120) and the Oregon Health Plan (OHP) Administrative Rules (OAR 410 division 141).
5. (5) The Health Services Commission's Prioritized List of Health Services is found on their website at: www.oregon.gov/OHA/HPA/CSI-Herc/Pages/Prioritized-List.aspx.

Statutory/Other Authority

ORS 413.042 & 676.730

Statutes/Other Implemented

ORS 414.025 & 414.065

History

DMAP 12-2025, minor correction filed 01/09/2025, effective 01/09/2025
DMAP 51-2023, amend filed 06/30/2023, effective 06/30/2023
DMAP 47-2018, minor correction filed 05/25/2018, effective 05/25/2018
DMAP 43-2011, f. 12-21-11, cert. ef. 1-1-12
DMAP 19-2008, f. 6-13-08, cert. ef. 7-1-08
OMAP 13-2004, f. 3-11-04, cert. ef. 4-1-04
OMAP 40-2001, f. 9-24-01, cert. ef. 10-1-01
OMAP 31-2000, f. 9-29-00, cert. ef. 10-1-00
HR 23-1997, f. & cert. ef. 10-1-97
HR 6-1994, f. & cert. ef. 2-1-94
HR 10-1990, f. 3-30-90, cert. ef. 4-1-90, Renumbered from 461-014-0500
AFS 48-1989, f. & cert. ef. 8-24-89, Renumbered from 461-014-0001
AFS 5-1989(Temp), f. 2-9-89, cert. ef. 3-1-89
AFS 50-1986, f. 6-30-86, cert. ef. 8-1-86
AFS 27-1982, f. 4-22-82 & AFS 51-1982, f. 5-28-82, cert. ef. 5-1-82 for providers located in the geographical areas covered by the AFS branch offices located in North Salem, South Salem, Dallas, Woodburn, McMinnville, Lebanon, Albany and Corvallis, cert. ef. 6-30-82 for remaining AFS Branch offices
AFS 36-1981, f. 6-29-81, cert. ef. 7-1-81
PWC 868, f. 12-30-77, cert. ef. 2-1-78