1. (1) The Division of Medical Assistance Programs (Division) uses HIPAA compliant modifiers for many services.

2. (2) The following conditions require the use of a modifier for all codes:

   1. (a) Family Planning Service — FP, Refer to OAR 410-130-0585 Family Planning Services
   2. (b) Vaccine for Children — SL or 26, Refer to OAR 410-130-0255(4)

3. (3) When billing for services that are reimbursed outside a clinic’s encounter rate, a clinic must use the required modifier(s) listed in the individual program Administrative Rules.

   1. (a) Enhanced Care Services (including extended care) — HK, Refer to OAR 410-147-0120;
   2. (b) Assist surgeon for cesarean deliveries for Citizenship Waived Medical (CWM) clients — 80, 81, 82 or AS.

Statutory/Other Authority

ORS 413.042 & 414.065

Statutes/Other Implemented

ORS 414.065

History

DMAP 16-2022, minor correction filed 02/16/2022, effective 02/16/2022
DMAP 34-2008, f. 11-26-08, cert. ef. 12-1-08
OMAP 27-2006, f. 6-14-06, cert. ef. 7-1-06
OMAP 71-2003, f. 9-15-03, cert. ef. 10-1-03
OMAP 63-2002, f. & cert. ef. 10-1-02