OAR 410-140-0120
ICD-10-CM Diagnosis, CPT/HCPCs Procedure Codes, and Modifiers


Providers shall use an International Classification of Diseases, 10th revision, Clinical Modification (ICD-10-CM) diagnosis code on all claims.


Providers shall provide the client’s diagnosis to ancillary service providers (e.g., SWEEP Optical Laboratories) when prescribing services, equipment, and supplies.


Providers shall use the standardized code sets required by the Health Insurance Portability and Accountability Act (HIPAA) and adopted by the Centers for Medicare and Medicaid Services (CMS). Providers shall accurately code claims using the combination of Health Care Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT) codes in effect for the date the service was provided:


Providers may not bill CPT or HCPCS procedure codes for separate procedures when a single CPT or HCPCS code includes all services provided. Providers shall comply with published coding guidelines;


Intermediate and comprehensive ophthalmological services as described under the ophthalmology section of the CPT codebook shall be billed using codes included under this section and not those included under the Evaluation and Management section;


When there is no appropriate descriptive procedure code to bill the Division, the provider shall use the code for “unlisted services.”


The Division recognizes HIPAA compliant modifiers in coding.
[Publications: Publications referenced are available from the agency.]

Source: Rule 410-140-0120 — ICD-10-CM Diagnosis, CPT/HCPCs Procedure Codes, and Modifiers, https://secure.­sos.­state.­or.­us/oard/view.­action?ruleNumber=410-140-0120.

Last Updated

Jun. 8, 2021

Rule 410-140-0120’s source at or​.us