When does this change take effect?

This change is effective Jan 20, 2026.

MedicaidAdministrativeMedium impact

Resolving conflicts between OARs 410-130-0700 and 410-130-0220

Q: Who is affected by this change?

This affects Oregon Health Plan General Surgery, Orthopedics, ENT (Ear, Nose & Throat), Ophthalmology, Urology, OB-GYN providers in OR on Medicaid plans.

Oregon Health Plan·OR · General Surgery, Orthopedics, ENT (Ear, Nose & Throat) +3 more·Plan contract

Effective date

Jan 20, 2026

We identified it

Jun 20, 2026

Days to comply

—

Summary

Oregon Health Authority has identified conflicting requirements between two administrative rules (OARs 410-130-0700 and 410-130-0220) regarding which procedure codes are bundled for medical surgical professional services. Until the conflict is resolved, Coordinated Care Organizations (CCOs) must follow OAR 410-130-0220 when the rules conflict.

Action Required

Action needed

Immediately: For Oregon Medicaid CCO contracts, billing team must apply bundling requirements from OAR 410-130-0220 when conflicts exist with OAR 410-130-0700 for medical surgical professional services. Review temporary rule filing effective 1/20/2026 through 7/18/2026 on Oregon's Chapter 410 Temporary Rule Filings page. This primarily affects payments to non-participating providers.

Related policy hubs

Oregon Health Plan policies OR policy changes General Surgery Orthopedics ENT (Ear, Nose & Throat)Ophthalmology Urology OB-GYN