OAR 410-123-1220
Coverage According to the Prioritized List of Health Services

(1) This rule incorporates by reference the “Covered and Non-Covered Dental Services” data base located at: https://data.oregon.gov/Health-Human-Services/Oregon-Medicaid-Covered-and-Non-Covered-Dental-Cod/5t6q-5tkx/data and dated January 1, 2021.
(a) The “Covered and Non-Covered Dental Services” data base lists coverage of Current Dental Terminology (CDT) procedure codes according to the Oregon Health Evidence Review Commission (HERC) Prioritized List of Health Services (Prioritized List) and the client’s specific Oregon Health Plan benefit package;
(b) This document is subject to change if there are funding changes to the Prioritized List.
(2) Changes to services funded on the Prioritized List are effective on the date of the Prioritized List change:
(a) The Division administrative rules (chapter 410, division 123) do not reflect the most current Prioritized List changes until the rules are amended through the Division rule filing process;
(b) For the most current Prioritized List, refer to the HERC website at www.oregon.gov/oha/herc/Pages/PrioritizedList.aspx;
(c) In the event of an alleged variation between a Division-listed code and a national code, the Division shall apply the national code in effect on the date of request or date of service.
(3) Refer to OAR 410-123-1260 (OHP Dental Benefits) and it’s referenced data base for information about limitations on procedures funded according to the Prioritized List. Examples of limitations include frequency and client’s age.
(4) The Prioritized List does not include or fund the following general categories of dental services, and the Division does not cover them for any client. Several of these services are considered elective or “cosmetic” in nature (i.e., done for the sake of appearance):
(a) Desensitization;
(b) Implant and implant services;
(c) Mastique or veneer procedure;
(d) Orthodontia (except when it is treatment for cleft palate, cleft lip, or cleft palate with cleft lip);
(e) Overhang removal;
(f) Procedures, appliances, or restorations solely for aesthetic or cosmetic purposes;
(g) Temporomandibular joint dysfunction treatment; and
(h) Tooth bleaching.

Source: Rule 410-123-1220 — Coverage According to the Prioritized List of Health Services, https://secure.­sos.­state.­or.­us/oard/view.­action?ruleNumber=410-123-1220.

Last Updated

Jun. 8, 2021

Rule 410-123-1220’s source at or​.us