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Oregon Health Authority

Prioritized List of Health Services

The Prioritized List and Oregon Health Plan

The Prioritized List is only one part of determining if the Oregon Health Plan (OHP) covers a service.

  • OHP routinely covers diagnostic and ancillary services.
  • OHP may decide to cover other services based on policy or individual review.

The Prioritized List does not affect coverage for members who have Early and Periodic Diagnostic, Screening and Treatment (EPSDT) benefts. These are members who:

  • Are under age 21 or
  • Are under age 26 and have Young Adults with Special Health Care Needs (YSHCN) benefits. 

OHP covers all medically necessary and medically appropriate services for these members. To learn more, visit OHA's EPSDT page.

Questions and Answers about the Prioritized List

The Oregon Health Evidence Review Commission (HERC) ranks health care condition and treatment pairs in order of clinical effectiveness and cost-effectiveness.

The Prioritized List emphasizes prevention and patient education. In general:

  • Treatments that help prevent illness are ranked higher than services that treat illness after it occurs.
  • OHP covers treatments that are ranked on a covered Prioritized List line for the client's reported medical condition.

Effective Jan. 1, 2024, OHP covers Prioritized List lines 1 through 469.

Effective Jan. 1, 2023, OHP covers all medically necessary and medically appropriate services for members under age 21. This is true even if the services are below line 469. To learn more, visit OHA's EPSDT page​. 

Effective Jan. 1, 2025, OHP covers all medically necessary and medically appropriate services for members under age 26 with Young Adults with Special Health Care Needs (YSHCN) benefits. This is true even if the services are below line 469. To learn more, visit OHA's YSHCN or EPSDT​ page. 

Use the following links on the HERC website. You can also subscribe to receive email notifications from HERC. HERC sends updates whenever Prioritized List information changes.

For OHA policies related to Prioritized List coverage or exclusions, see the General Rules, Oregon Health Plan rules, and the provider guidelines specific to your program.

To find out whether a specific procedure is potentially covered according to the Prioritized List, providers can:

  • Use the HSC List inquiry on the Oregon Medicaid Provider Portal at www.or-medicaid.gov. This inquiry can tell you the specific line placement for the treatment/condition pair; or 
  • Call the OHP Code Pairing and Prioritized List Hotline at 800-336-6016. ​
The list prioritizes treatment (procedure code) and condition (diagnosis code) pairs. To use the Prioritized List, you need to know :
  • The treatment you want to know about, and
  • The condition it would treat.

OHP covers all medically necessary and medically appropriate services for OHP members who:

  • Are under age 21 or
  • Are under age 26 and have Young Adults with Special Health Care Needs (YSHCN) benefits.

To learn more, visit OHA's ESPDT page​.​


Learn More

Visit the Health Evidence Review Commission's Prioritized List of Health Services page.

For detailed information about the creation of the Prioritized List, view:

Questions?

About Prioritized List updates: Email the Health Evidence Review Commission.

About OHP coverage of specific treatment/condition pairs: Providers can call the OHP Code Pairing and Prioritized List Hotline at 800-336-6016 (option 4) or 503-945-5939.