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

(1)

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

(2)

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

(3)

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:

(a)

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;

(b)

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;

(c)

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

(4)

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.

410‑140‑0020
Service Delivery 410‑140‑0040
Prior Authorization 410‑140‑0050
Eligibility and Benefit Coverage 410‑140‑0080
Medicare/Medicaid Assistance Program Claims 410‑140‑0120
ICD-10-CM Diagnosis, CPT/HCPCs Procedure Codes, and Modifiers 410‑140‑0140
Vision Services Coverage and Limitations 410‑140‑0160
Contact Lens Services and Supplies 410‑140‑0200
Dispensing, Fitting and Repair of Glasses 410‑140‑0260
Contractor Services for Provider Ordering Vision Materials and Supplies 410‑140‑0280
Vision Therapy Services 410‑140‑0300
Post-operative Care 410‑140‑0400
Contractor Services/Provider Ordering

Last Updated

Jun. 8, 2021

Rule 410-140-0120’s source at or.us

Stay Connected

Join thousands of people who receive monthly site updates.

Get Legal Help

The Oregon State Bar runs a service for finding an attorney in good standing. Initial consultations are usually free or discounted: Lawyer Referral Service

Committed to Public Service

We will always provide free access to the current law. In addition, we provide special support for non-profit, educational, and government users. Through social entrepreneurship, we’re lowering the cost of legal services and increasing citizen access.

Navigate

California:	Codes
Colorado:	C.R.S.
Nevada:	NRS
New York:	Laws
Oregon:	OAR, ORS
Texas:	Statutes
World:	Rome Statute, International Dictionary

Location: https://oregon.public.law/rules/oar_410-140-0120

Original 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 accessed Jun. 8, 2021).

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

(1)

(2)

(3)

(a)

(b)

(c)

(4)

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