Oregon Billing Guide for Mental Health Therapists and Psychiatrists
Who pays, where to enroll and which rules change your claims in Oregon, for psychotherapists and psychiatric prescribers.
Last checked October 25, 2026. Reviewed against the official sources listed at the bottom of this page.
This Oregon billing guide covers Medicaid, Medicare, Blue Cross, other private payers and state law for therapists and psychiatrists, with sources and a last-checked date.
Oregon billing guide: how Oregon pays for outpatient care
The Oregon Health Authority (OHA) runs the Oregon Health Plan (OHP), Oregon's Medicaid program. Most members are enrolled in coordinated care organizations (CCOs) that cover behavioral health, and you bill the CCO directly. OHA pays fee-for-service claims through the Oregon Medicaid Provider Portal.
Oregon's expansion adults face a work or activity requirement from January 1, 2027, according to OHA. American Indian and Alaska Native members are not enrolled in a CCO, and OHA pays their behavioral health care fee-for-service.
Who to bill, at a glance
| Payer type | Who you bill | Where to enroll or check rules |
|---|---|---|
| Medicaid (Oregon Health Plan) | Oregon Health Authority; CCOs; open-card fee-for-service | Provider enrollment |
| Medicare Part B | Noridian Healthcare Solutions, Jurisdiction F | CMS MAC page |
| Blue Cross Blue Shield | Regence BlueCross BlueShield of Oregon | See the Blue Cross section below |
Oregon Medicaid: Oregon Health Plan (OHP)
This Oregon billing guide starts with Medicaid, because it decides who pays and how you file.
OHA describes CCOs as covering physical and behavioral health. Medicare members must use a CCO for dental and mental health care. Open-card fee-for-service applies to some members, including American Indian and Alaska Native members not enrolled in a CCO.
No separate statewide behavioral health carve-out vendor was found. CCO credentialing is handled by each CCO.
| Item | What to know |
|---|---|
| Agency | Oregon Health Authority, Health Systems Division |
| Fee-for-service claims | Use the Oregon Medicaid Provider Portal or EDI with payer ID ORDHS, or paper to OHP at PO Box 14955, Salem, OR 97309. CCO members: bill the CCO, not OHA. OHA billing page |
| Provider enrollment | Enroll through the OHA enrollment site or the portal. Individual practitioners billing directly enroll as Payable Individual providers. OHA enrollment |
| Fee-for-service filing window | Claims must be filed within 12 months of the date of service (OAR 410-120-1300). A claim denied within 12 months can be resubmitted up to 18 months from service. Later claims need the Request to Bypass Timely Filing form. Resolve claims |
| CCO filing window | OHA guidance dated 5/13/2020, citing OAR 410-141-3565, describes a four-month initial billing period with exceptions up to 12 months. Individual CCOs may differ, so check each plan. |
| Fee schedule | OHA posts a fee-for-service fee schedule and a behavioral health fee schedule. CCOs need not use the posted schedule for contracted providers. OHA fee schedule |
| Work requirement | OHA says work or other activity requirements begin January 1, 2027 for adults ages 19 to 64: 80 hours a month of work, volunteering or school, or an exemption. Exempt groups include people in substance use treatment, people on Medicare and American Indians and Alaska Natives. OHA says details may change. OHA talking points, updated 6/9/2026 |
Managed-care plans and carve-outs
| Plan or entity | Role in behavioral health |
|---|---|
| AllCare, Advanced Health and Cascade Health Alliance | Named on the OHA CCO map dated March 2026. |
| Columbia Pacific and Eastern Oregon CCOs | Named on the OHA CCO map. |
| Health Share of Oregon | Plans include CareOregon, Kaiser Permanente Northwest, Legacy and PacificSource, OHSU Health and Providence. |
| InterCommunity Health Network, Jackson Care Connect, Umpqua Health Alliance and Yamhill Community Care | Named on the OHA CCO map. |
| PacificSource Community Solutions | OHA says PacificSource is no longer a CCO in Lane County from early 2026. |
| Trillium Community Health Plan | Takes Lane County members on or after February 1, 2026. |
Check the OHA CCO page and the CCO changes page for current service areas.
Medicare Part B in Oregon
For Medicare, this Oregon billing guide names your contractor and the current telehealth rules.
Medicare Part B pays for outpatient psychotherapy and psychiatric visits billed to the Medicare Administrative Contractor (MAC) for your state. CMS's July 14, 2026 fact sheet on the CY2027 Physician Fee Schedule proposed rule says the Consolidated Appropriations Act, 2026 extended telehealth payment authority through December 31, 2027, and proposes that in-person visit requirements for mental health visits not apply to services furnished through that date.
| Item | What to know |
|---|---|
| Contractor | Noridian Healthcare Solutions, LLC |
| Jurisdiction | Jurisdiction F: Alaska, Arizona, Idaho, Montana, North Dakota, Oregon, South Dakota, Utah, Washington and Wyoming |
| Source | CMS.gov MAC page |
Blue Cross Blue Shield in Oregon
This part of the Oregon billing guide names the exact Blue Cross licensee, because Blue plans never share rules.
Blue Cross Blue Shield is a federation of independent companies, so one licensee's rules never apply to another. In Oregon that is Regence BlueCross BlueShield of Oregon, part of Cambia Health Solutions. Regence calls itself a nonprofit independent licensee of the Blue Cross and Blue Shield Association. Do not apply Oregon rules to Regence BlueShield in Washington, to Regence in Idaho or Utah, or to other Blue plans.
| Licensee | Parent or affiliation | Where it applies | Provider resources |
|---|---|---|---|
| Regence BlueCross BlueShield of Oregon | Cambia Health Solutions | Oregon | Regence behavioral health providers |
Other private payers and EAPs in Oregon
The Oregon billing guide also covers commercial plans and employee assistance programs.
These commercial payers and plan families most often matter for behavioral health billing in Oregon. Check each payer's current provider manual before you submit.
| Payer | Behavioral health note | Provider resources |
|---|---|---|
| Moda Health | Moda's Oregon provider page says claims in most cases must be submitted no later than 365 days after the date of service, with payer ID 13350. | Official page |
Oregon billing guide: state law that changes billing
Use this section of the Oregon billing guide to separate state law from payer policy.
State law sets the floor for commercial plans in Oregon. Medicare and Medicaid rules are covered in their own sections above.
Mental health parity
ORS 743A.168 covers mental health and chemical dependency treatment. HB 3046 (2021) requires insurers to analyze non-quantitative treatment limits each year and report to the Division of Financial Regulation. DFR parity report, 2023
Telehealth coverage
ORS 743A.058, as amended in 2021 (HB 2508), requires health plans to cover telemedicine for covered services when medically necessary and safe. OHA must reimburse telemedicine, including audio-only, at the same rate as in person. Oregon Laws 2021, ch. 117
Prompt payment
The Division of Financial Regulation's prompt payment reporting cites ORS 743B.450 and 743B.452. Check the statute for deadlines and interest. OHA resolve claims
Not legal advice. Confirm statute details with counsel.
Oregon billing guide: codes and rates
This Oregon billing guide lists only codes and rates confirmed on official pages.
These are the Oregon-specific codes, modifiers and rate items confirmed on official pages. Medicare's own CY2027 conversion factor proposal is listed under What changed.
| Code or item | What to know |
|---|---|
| Behavioral health fee schedule | OHA's fact sheet says legislatively approved rates are generally 70 percent of Medicare rates. CCOs must pay fee-for-service rates to non-contracted providers under OAR 410-120-1295. OHA fee schedule |
| Behavioral health rate increases | OHA reports an average 30 percent fee-for-service increase retroactive to July 1, 2022 (HB 5202) and a 3.4 percent increase on October 1, 2023. OHA rates page |
| Claim forms | CMS-1500 for professional claims and UB-04 for institutional. The NPI on the claim must match the NPI on file for the Oregon Medicaid ID. OHA billing page |
Oregon billing guide: what changed, newest first
Check this Oregon billing guide update log before you rely on an older rule.
| Date | What changed | Source |
|---|---|---|
| 2026-10-08 | CMS updated its Telehealth FAQ: Medicare telehealth flexibilities run through 12/31/2027. | Source |
| 2026-10 | OHA planned an informational work requirement notice to members. | Source |
| 2026-07-14 | CMS released the CY2027 Medicare Physician Fee Schedule proposed rule: conversion factor $32.84 for non-qualifying APM participants (down 1.68%) and $33.17 for qualifying participants (down 1.19%). | Source |
| 2026-06-09 | OHA updated its H.R. 1 talking points: work requirements start January 1, 2027. | Source |
| 2026-03 | OHA published its March 2026 CCO map. | Source |
| 2026-02-01 | Trillium takes over Lane County CCO members. | Source |
How do I bill mental health claims in Oregon?
These answers come from the same sources as the rest of this Oregon billing guide.
Check the member's coverage first. For CCO members, bill the CCO, which may set a shorter filing window than OHA. For fee-for-service members, bill OHA within 12 months of the date of service. Medicare Part B goes to Noridian in Jurisdiction F. Regence BlueCross BlueShield of Oregon is the independent Blue licensee.
Questions about billing in Oregon
Who do I bill for Oregon Medicaid behavioral health claims?
Bill the member's CCO. Bill OHA only for fee-for-service members.
What is the Oregon Medicaid timely filing limit?
Fee-for-service claims must be filed within 12 months of the date of service. CCOs may set shorter windows, so check each plan.
Who is the Blue Cross licensee in Oregon?
Regence BlueCross BlueShield of Oregon, an independent licensee. Do not apply its rules to other Regence plans.
When do Oregon Medicaid work requirements start?
OHA says January 1, 2027 for adults ages 19 to 64, with exemptions.
Does MCM South bill for practices in Oregon?
MCM South currently serves ten states; request a quote to ask about Oregon.
Sources for the Oregon billing guide
Last checked October 25, 2026. Every source below was opened and read on that date.
- Oregon Health Authority billing page, checked October 25, 2026
- OHA provider enrollment, checked October 25, 2026
- OHA resolve claims, checked October 25, 2026
- OHA fee schedule, checked October 25, 2026
- OHA behavioral health rates, checked October 25, 2026
- OHA CCOs, checked October 25, 2026
- OHA CCO changes, checked October 25, 2026
- OHA CCO map, March 2026, checked October 25, 2026
- OHA H.R. 1 talking points, checked October 25, 2026
- Oregon DFR parity report 2023, checked October 25, 2026
- Oregon Laws 2021, ch. 117, checked October 25, 2026
- Regence behavioral health providers, checked October 25, 2026
- Moda Health Oregon claims, checked October 25, 2026
- CMS: MAC Jurisdiction F, checked October 25, 2026
- CMS Telehealth FAQ, October 2026, checked October 25, 2026
- CMS: CY2027 Physician Fee Schedule proposed rule fact sheet, checked October 25, 2026
- CMS MAC jurisdiction page, checked October 25, 2026
Related guides
- State & Regional Billing Guides hub
- In-network vs out-of-network credentialing
- Credentialing and network status
- Mental health parity explained
- Medicaid managed care billing
- Medicare behavioral health billing
- Timely filing in the billing glossary
- Who we serve
- Washington insurance companies contact guide
- California insurance companies contact guide
Billing in Oregon? Let us handle the payer calls.
MCM South bills only mental and behavioral health, for psychotherapists and psychiatrists, in solo and medium-size practices. We currently serve ten states; request a quote to ask about Oregon.
MCM South currently serves practices in ten states: Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois.