OHP FFS Fee Schedule Specifications Last updated 03/01/2017
File specifications for the Oregon Health Plan fee-for-service
fee schedule
Current file specifications
Field
Description
Procedure
Code
Procedure Code - For billing purposes, OHA uses Current Procedural
Terminology (CPT), Level III National Codes (HCPCS) and Current Dental
Terminology (CDT).
Description
Procedure code description
Modifier 1
First modifier associated with procedure code. (Blank indicates no modifier.)
Rate Type
"A" = Ambulatory surgical rate
“B” = Birthing center rate
“P” = Oregon’s primary care rate
“F” = 2013-2014 federal primary care rate
If this field is blank, the rate is not an ambulatory surgical rate, a birthing
center rate, or a primary care rate.
RBRVS Place
of Service
“Fac” = RBRVS Facility rate
“Non” = RBRVS Non-Facility rate
If this field is blank, the rate is not based on the Resource-Based Relative
Value Scale (RBRVS).
Price
Price effective during month reported.
Effective Date
Date current price became effective (YYYYMMDD)
July 2011 to December 2013
Field
Description
Procedure
Code
Procedure Code - For billing purposes, OHA uses Current Procedural
Terminology (CPT), Level III National Codes (HCPCS) and Current Dental
Terminology (CDT).
Description
Procedure code description
Modifier 1
First modifier associated with procedure code. (Blank indicates no modifier.)
Modifier 2
Second modifier associated with procedure code. (Blank indicates no
modifier.)
Rate Type
"A" = Ambulatory surgical rate
“P” = Oregon’s primary care rate
“F” = 2013-2014 federal primary care rate
If this field is blank, the rate is not an ambulatory surgical rate or a primary
care rate.
Price
Price effective during month reported.
Effective Date
Date current price became effective (YYYYMMDD)
HEALTH SYSTEMS DIVISION
Integrated Health Programs
OHP FFS Fee Schedule Specifications Last updated 03/01/2017
March 2009 to May/June 2011
Field
Description
Procedure
Code
Procedure Code - For billing purposes, OHA uses Current Procedural
Terminology (CPT), Level III National Codes (HCPCS) and Current Dental
Terminology (CDT).
Description
Procedure code description
Modifier 1
First modifier associated with procedure code. (Blank indicates no modifier.)
Modifier 2
Second modifier associated with procedure code. (Blank indicates no
modifier.)
ASC
A "Y" in this field indicates that this rate is an ambulatory surgical rate. If this
field is blank, the rate is not an ambulatory surgical rate.
Price
Price effective during month reported.
Effective Date
Date current price became effective (YYYYMMDD)
