Or. Admin. R. 436-009-0004 – Adoption of Standards

(1) The director adopts, by reference, the American Society of Anesthesiologists ASA, Relative Value Guide 2026 as a supplementary fee schedule for those anesthesia codes not found in Appendix B. To get a copy of the ASA Relative Value Guide 2026, contact the American Society of Anesthesiologists, 1061 American Lane, Schaumberg, IL 60173, 847-825-5586, or www.asahq.org.
(2) The director adopts, by reference, the American Medical Association’s (AMA) Current Procedural Terminology (CPT® 2026), Fourth Edition Revised, 2025, for billing by medical providers. The definitions, descriptions, and guidelines found in CPT® 2026 govern the descriptions of services, except as otherwise provided in these rules. The guidelines are adopted as the basis for determining level of service.
(3) The director adopts, by reference, the AMA’s CPT® Assistant, Issue 04, 1990 through Issue 12, 2025. If there is a conflict between CPT® 2026 and the CPT® Assistant, CPT® 2026 is the controlling resource.
(4) To get a copy of the CPT® 2026, or the CPT® Assistant, contact the American Medical Association, AMA Plaza, 330 N. Wabash Ave., Suite 39300, Chicago, IL 60611-5885, 312-464-4782, or www.ama-assn.org.
(5) The director adopts, by reference, only the alphanumeric codes from the CMS Healthcare Common Procedure Coding System (HCPCS). These codes are to be used when billing for services, but only to identify products, supplies, and services that are not described by CPT® codes or that provide more detail than a CPT® code.
1. (a) Except as otherwise provided in these rules, the director does not adopt the HCPCS edits, processes, exclusions, color-coding and associated instructions, age and sex edits, notes, status indicators, or other policies of CMS.
2. (b) To get a copy of the HCPCS, contact the National Technical Information Service, Springfield, VA 22161, 800-621-8335 or www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/Alpha-Numeric-HCPCS.html.
(6) The director adopts, by reference, CDT 2026: Dental Procedure Codes, to be used when billing for dental services. To get a copy, contact the American Dental Association at American Dental Association, 211 East Chicago Ave., Chicago, IL 60611-2678, 312-440-2500, or www.ada.org.
(7) The director adopts, by reference, the 02/12 1500 Claim Form and Version 13.0 7/25 (for the 02/12 form) 1500 Health Insurance Claim Form Reference Manual published by the National Uniform Claim Committee (NUCC). To get copies, contact the NUCC, American Medical Association, PO Box 74008935, Chicago, IL 60674-8935, or www.nucc.org.
(8) The director adopts, by reference, the Official UB-04 Data Specifications Manual 2025 Edition, published by National Uniform Billing Committee (NUBC). To get a copy, contact the NUBC, American Hospital Association, 155 North Wacker Drive, Suite 400, Chicago, IL 60606, 312-422-3000, or www.nubc.org.
(9) The director adopts, by reference, the NCPDP Manual Claim Forms Reference Implementation Guide Version 1.4 (7/2015) and the NCPDP Workers’ Compensation/Property & Casualty Universal Claim Form (WC/PC UCF) Version 1.1 –5/2009. To get a copy, contact the National Council for Prescription Drug Programs (NCPDP), 9240 East Raintree Drive, Scottsdale, AZ 85260-7518, 480-477-1000, or www.ncpdp.org.
(10) Specific provisions contained in OAR chapter 436, divisions 009, 010, and 015 control over any conflicting provision in ASA Relative Value Guide 2026, CPT® 2026, CPT® Assistant, HCPCS 2026, CDT 2026. 1500 Health Insurance Claim Form Reference Instruction Manual, Official UB-04 Data Specifications Manual, or NCPDP Manual Claim Forms Reference Implementation Guide.
(11) Copies of the standards referenced in this rule are also available for review during regular business hours at the Workers’ Compensation Division, Medical Resolution Team, 350 Winter Street NE, Salem, OR 97301.

Statutory/Other Authority

ORS 656.248 & ORS 656.726(4)

Statutes/Other Implemented

ORS 656.248

History