MedicaidReimbursementMedium impact
Notice of intent: OHA will amend the Medicaid State Plan to increase the rate for two newborn procedure codes.
Oregon Health Plan·OR · Pediatrics, Critical Care·Public notice
Effective date
Oct 1, 2025
We identified it
Jun 20, 2026
Summary
Oregon Medicaid is increasing reimbursement rates for newborn procedure codes 99464 and 99465 to match the higher conversion factor of $38.76 that was previously applied to other neonatal intensive care codes. This corrects an oversight from a previous rate increase.
Action Required
Monitor for State Plan Amendment approval: Once CMS approves this amendment (expected mid-2025), billing team should verify that Oregon Medicaid claims for CPT codes 99464 and 99465 are reimbursing at the increased rate of $38.76 conversion factor. No immediate action required as this is currently in public comment period until January 10, 2025.