Or. Admin. Code § 410-129-0085 - Payment Methodology

(1) Speech-Language Pathology and Audiology outpatient services are priced based on RVU (Refer to OAR 410-120-1340(6)) and flat fee rates:

(a) Surgical procedures such as cochlear implants may be provided in a hospital or Ambulatory Surgical Center (ASC) (Refer to OAR 410-120-1340 (6) and (8));

(b) The Division reimburses inpatient hospital service under the DRG methodology, unless specified otherwise in the Division's Hospital Services program administrative rules, chapter 410, division 125.

(2) The Division shall reimburse the following codes, using 75 percent of the Manufacturer's Suggested Retail Price (MSRP). This is verifiable with quote, invoice, or bill from the manufacturer that clearly states the amount indicated is MSRP all require PA:

(a) E2599 (Accessory for SGD, not otherwise classified) and reimbursement shall be capped at $6,200;

(b) E2512 (SGD accessory, mounting system) and reimbursement shall be capped at $3,300;

(c) L8690 (Auditory osseointegrated device, includes all internal and external components)

(d) L8691(Auditory osseointegrated device, external sound processor, excludes transducer/actuator, replacement only, each) and reimbursement shall be capped at $1,888.94;

(e) L8692 (Auditory osseointegrated device, external sound processor, used without osseointegration, body worn) and reimbursement shall be capped at $2,045.20;

(f) L8693 (Auditory osseointegrated device abutment, any length, replacement only);

(g) L8694 (Audiory osseointegrated device, transducer/actuator, replacement only, each);

(h) V5281 (Assistive Listening Device (Ald) fm/dm system, monaural;

(i) V5282 (Ald fm/dm system, binaural);

(j) V5283 (Ald neck, loop induction receiver);

(k) V5284 (Ald fm/dm ear level receiver);

(l) V5285 (Ald fm/dm aud input receiver);

(m) V5286 (Ald blu tooth fm/dm receiver);

(n) V5287 (Ald fm/dm receiver, nos);

(o) V5288 (Ald fm/dm transmitter ald);

(p) V5289 (Ald fm/dm adapt/boot coupling device for receiver); and

(q) V5290 (Ald transmitter microphone).

Notes

Or. Admin. Code § 410-129-0085

DMAP 30-2018, temporary adopt filed 05/17/2018, effective 05/17/2018 through 11/12/2018; DMAP 100-2018, adopt filed 11/06/2018, effective 11/6/2018; DMAP 46-2021, amend filed 10/22/2021, effective 10/22/2021; DMAP 93-2023, amend filed 12/21/2023, effective 1/1/2024

Statutory/Other Authority: ORS 413.042 & ORS 414.065

Statutes/Other Implemented: ORS 414.065 & ORS 414.025