If you bill services under the Oregon Health Plan, the Oregon Medicaid Fee Schedule 2027 is the resource you use to find fee-for-service reimbursement amounts from the Oregon Health Authority (OHA). Medical, dental, behavioral health, and other program-specific schedules each live separately — so where you look depends on what you’re billing.
One thing worth knowing before you start: verify the official schedule and confirm the effective date actually covers your dates of service. An old rate from the wrong file can cause real problems downstream.
The official OHA fee schedule is available through the Oregon Health Authority’s OHP Fee-for-Service Fee Schedule page.
What Is the Oregon Medicaid Fee Schedule 2027?
OHA’s fee-for-service schedules cover services billed directly to the agency. Right there is the distinction that catches providers off guard: if your patient is enrolled in a Coordinated Care Organization (CCO), the OHA schedule doesn’t govern what you get paid. You go to the CCO for those rates.
For FFS services, the schedule is your reference for procedure codes, amounts, and claim preparation requirements across medical, dental, and behavioral health.
Wondering how Oregon stacks up against other states? This Medicaid fee schedule by state overview provide you a solid comparison before you go deep on Oregon-specific policies.
Is the Oregon Medicaid Fee Schedule for 2027 Available?
Go check OHA’s official fee-schedule page directly. That’s the only reliable answer.
OHA posts schedules and updates as they’re ready. Medical-dental files reflect what was available in the month they were posted. Behavioral health and Health-Related Social Needs schedules show rates effective on or after their listed schedule dates. Here’s something people miss: publication date and effective date are two different things. A file posted in 2027 doesn’t automatically mean every rate it contains became effective in 2027.
Before pulling a number from any schedule, nail down:
- The actual date of service
- The procedure code and any required modifiers
- Provider type and service setting
- Whether your patient is FFS or CCO-enrolled
- Any coverage, authorization, or billing restrictions
If the specific 2027 rate hasn’t been published yet, work from the latest official schedule. An unverified estimate is not a substitute.
Where to Download the Oregon Medicaid Fee Schedule 2027
Start at OHA’s official OHP Fee-for-Service Fee Schedule page — not a cached version, not a third-party copy.
Step 1: Open the official website.
Go directly to the source. Third-party copies get stale fast and carry no accountability.
Step 2: Select the relevant service category.
Medical-dental, behavioral health, and other services have their own separate resources. Don’t assume the medical schedule covers everything.
Step 3: Find the appropriate file.
Pull the latest available schedule. Use the page’s search function when you need an older effective date for a past date of service.
Step 4: Check the effective date.
This isn’t optional. A rate is only valid if it aligns with when the service actually happened. Read the notes on any code-specific changes before using a number.
Step 5: Verify the code and billing requirements.
Confirm the procedure code, any required modifiers, provider qualifications, coverage requirements, and prior authorization criteria. Do this before submitting — not after a denial.
OHA publishes medical-dental schedules in PDF, Excel, and CSV. Behavioral health schedules come in Excel. File availability and publication timelines can shift without warning.
What Services Are Included in Oregon Medicaid Fee Schedules?
The right schedule depends entirely on what’s being billed and how the patient is covered. No single file captures everything.
| Fee Schedule Category | What Providers Can Research |
|---|---|
| Medical services | Applicable procedure codes and fee-for-service rates |
| Dental services | Covered dental procedures and reimbursement information |
| Behavioral health | Mental health and substance use disorder services |
| Hospital services | Separate hospital payment resources, including DRG information |
| Pharmacy | Drug pricing and reimbursement resources |
| Health-Related Social Needs | Program-specific rates and guidance |
If a service doesn’t show up in the general schedule, dig into the relevant program rules, provider guidelines, and contracts before assuming it’s simply not covered.
Oregon Medicaid CPT and HCPCS Codes
Oregon Health Plan billing manage on standard procedure coding — Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), and Current Dental Terminology (CDT) where applicable.
The code identifies the service. What you actually get paid depends on the fee schedule plus a stack of other program requirements. One without the other is incomplete.
When you’re researching a code, run through this:
- Does OHA accept it?
- Is it covered under the patient’s specific OHP benefit package?
- Are you authorized to perform and bill for this service?
- Is a modifier, place-of-service code, or other claim detail required?
- Does the service need prior authorization or extra documentation?
- Does the listed rate apply to your actual date of service?
A code existing in a coding system means nothing on its own. Oregon Medicaid doesn’t cover every valid code in every setting. OHA points providers to its coverage guidance, administrative rules, and Prioritized List for the limitations that apply.
Oregon Medicaid Physician and Medical Reimbursement Rates
Physicians and eligible practitioners use the medical-dental fee schedule for FFS reimbursement research. Simple enough in theory.
Where it gets complicated: rates vary by service and billing requirements. An office visit, a procedure, a diagnostic test — none of these share a single statewide rate that applies in every situation. Assuming otherwise leads to billing errors.
What the schedule gives you is a reference amount for the FFS arrangement. It does not promise OHA will pay the claim. Eligibility, coverage, coding, and documentation requirements all affect the actual outcome.
Oregon Medicaid Dental Fee Schedule 2027
Dental providers should work from the medical-dental fee schedule plus any supplemental dental program guidance OHA has released.
Before billing a dental service, confirm the CDT code, provider eligibility, coverage requirements, frequency limitations, required documentation , and whether authorization is needed. For 2027 specifically — use the schedule that matches the date of treatment. Don’t assume a prior-year rate carries forward without verification.
Oregon Medicaid Behavioral Health Fee Schedule
Mental health and substance use disorder services typically live on a separate schedule. That matters practically: don’t go looking for behavioral health rates in the medical-dental file.
OHA publishes behavioral health schedules and policy updates on an ongoing basis. Rates and billing requirements shift, so pull the current file and check for recent announcements before billing. Confirm the service code, eligible rendering provider type, service setting, authorization requirements, and effective date every time.
Residential treatment and other specialized programs often carry additional payment rules or their own rate resources. For program-specific updates, the OHA Behavioral Health Services Rules and Guidelines page is where to look.
Fee-for-Service vs. CCO Reimbursement Rates
Honestly, this is the one that creates the most billing headaches — and it’s not complicated once you understand the split.
Fee-for-service: You bill OHA directly. The official fee schedule gives you reference amounts for eligible codes.
Coordinated Care Organization (CCO): The patient gets care through a CCO. You follow the member’s enrollment and billing instructions, and you contact the CCO for its rates, contract terms, and claim requirements. OHA’s schedule doesn’t apply here.
Check enrollment before you touch the claim. Bill the CCO when the patient’s enrolled in one; bill OHA when they’re not — subject to applicable program rules. Whatever OHA’s FFS schedule lists is irrelevant to your CCO payment negotiation.
Getting this wrong means a rejected claim and a delay in payment. Understanding which bucket the patient falls into is genuinely step one.
Oregon Medicaid Billing Guidelines for Providers
The fee schedule is one input. A clean claim requires everything else too. Run through this before you submit:
- Verify eligibility — Confirm coverage and enrollment for the actual date of service. Not the day before, not a general assumption.
- Identify the correct payer — OHA or the CCO. This drives everything downstream.
- Confirm coverage — OHP benefit rules, limitations, and exclusions apply. Know them.
- Check coding — Right CPT, HCPCS, or CDT code. Right claim details. No shortcuts.
- Confirm provider enrollment — Your identifiers and enrollment status need to be current and accurate.
- Review authorization requirements — If prior authorization is required, get it first.
- Keep documentation — Service date, rendering provider, billed amount, clinical support. Keep all of it.
- Check other insurance — If Medicare or another payer is involved, follow coordination-of-benefits rules.
For the official step-by-step, visit the OHA Billing for Oregon Health Plan Services page.
One more thing worth factoring in: Oregon Medicaid income limits shape who’s eligible for OHP coverage. Understanding that picture helps when you’re verifying whether a patient’s enrollment is current and what program they’re actually enrolled under.
How Often Does Oregon Update Its Medicaid Fee Schedule?
OHA updates files when rates or schedule information change — and the site explicitly notes that rates can change without notice. Plan accordingly.
Medical-dental files reflect what was available when posted. Only codes that changed in that month get a new effective date. Everything else in the same file may still reflect an older rate. Some schedules state that rates apply on or after the date shown.
Check the official page regularly. When you use a rate to support a claim, keep that version on file. If something looks off or unclear, call OHA or the relevant CCO before submitting. A quick confirmation call is less painful than a denial and a resubmission.
Contact Oregon Health Authority About Medicaid Rates
For fee-for-service rate questions, reach OHA Provider Services directly:
- Phone: 800-336-6016
- Email: dmap.providerservices@oha.oregon.gov
- Official fee schedule: https://www.oregon.gov/oha/hsd/ohp/pages/fee-schedule.aspx
For anything involving CCO members — reimbursement rates, billing instructions, contract questions — go to the CCO. OHA can’t answer those.
Frequently Asked Questions
Where can I find the Oregon Medicaid Fee Schedule 2027?
OHA’s official OHP Fee-for-Service Fee Schedule page. Pull the latest files and confirm the effective date lines up with your dates of service.
Are Oregon Medicaid rates for 2027 finalized?
Not necessarily across the board. Verify OHA’s latest publications and effective dates for the specific code you need before relying on any number.
Can I download the Oregon Medicaid fee schedule in Excel?
Yes — medical-dental schedules come in Excel, PDF, and CSV. Behavioral health is Excel only.
Does the Oregon Medicaid fee schedule include CPT and HCPCS codes?
It lists applicable procedure codes and FFS payment amounts. OHA uses CPT, HCPCS, and CDT where applicable, but coverage varies by setting. Not every valid code is a covered code.
Are CCO reimbursement rates the same as OHA fee-for-service rates?
No. OHA’s FFS schedule applies only to services billed directly to the agency. CCO rates are negotiated separately — contact the CCO.
Does a listed fee guarantee payment?
No, and OHA says so directly. Eligibility, coverage, coding, authorization, and documentation all factor in. A rate in the schedule is a reference, not a payment promise.
How can I find Oregon Medicaid dental rates for 2027?
Start with the medical-dental fee schedule. Verify the CDT code, effective date, and any additional dental guidance OHA has published for the service you’re billing.
Where can I find Oregon Medicaid behavioral health rates?
OHA’s fee-schedule portal and its behavioral health policy resources. Verify the service code, eligible provider type, effective schedule, and program-specific policies before billing anything.
Who should I contact about an Oregon Medicaid reimbursement rate?
For FFS queries: OHA Provider Services at 800-336-6016 or dmap.providerservices@oha.oregon.gov. For CCO questions: the applicable CCO.
Conclusion
The fee schedule tells you what a service is worth under FFS. It doesn’t tell you that the claim will pay, which payer to bill, or whether the patient is actually eligible. Those answers come from enrollment verification, coverage rules, and knowing whether you’re dealing with FFS or a CCO.
Use the right schedule, check the exact date, and confirm before you submit — because fixing a denial after the fact takes a lot more time than getting it right the first time.
Disclaimer: This guide is for educational purposes only and is not billing, legal, or reimbursement advice. Official OHA dates, effective schedule, program policy, and CCO contracts govern applicable payment requirements.