OAR 410-129-0085
Payment Methodology

(1) Speech-Language Pathology and Audiology outpatient services are priced based on RVU (Refer to OAR 410-120-1340 (Payment)(6)):
(a) Surgical procedures such as cochlear implants may be provided in a hospital or ambulatory surgical center (ASC) (Refer to OAR 410-120-1340 (Payment) (6) and (8));
(b) The Division reimburses inpatient hospital service under the DRG methodology, unless specified otherwise in the Division’s Hospital Services program administrative rules, chapter 410, division 125.
(2) The Division shall reimburse codes E2599 (Accessory for SGD, not otherwise classified) and E2512 (SGD accessory, mounting system) and any code that requires manual pricing, using 75 percent of the manufacturer’s suggested retail price (MSRP). This is verifiable with quote, invoice, or bill from the manufacturer that clearly states the amount indicated is MSRP.
(3) Reimbursement on code E2599 (SGD accessory, not otherwise classified) shall be capped at $6,200.
(4) Reimbursement on accessory code E2512 shall be capped at $3,300.
(5) PA is required for SGD accessory code E2599 when the cost is greater than $520.
(6) PA is required for miscellaneous accessory code E2512 when the cost is greater than $480.
(7) The Division shall reimburse codes L8690-L8694 using 75 percent of the manufacturer’s suggested retail price (MSRP). This is verifiable with quote, invoice, or bill from the manufacturer that clearly states the amount indicated is MSRP.

Source: Rule 410-129-0085 — Payment Methodology, https://secure.­sos.­state.­or.­us/oard/view.­action?ruleNumber=410-129-0085.

Last Updated

Jun. 8, 2021

Rule 410-129-0085’s source at or​.us