Oregon

Last updated 07/30/2025

Consent Requirements

Privacy and security standards for telehealth services must be met by satisfying the following:

• Prior to the delivery of services using a telehealth modality, a client or member’s written, oral, or recorded consent to receive services using a telehealth delivery method in the language that the client or member understands must be obtained and documented by the health system, clinic or provider in the client or member’s health record. Consent must include an assessment of client or member readiness to access and participate in telehealth delivered services, including conveying all other options for receiving the health care service to the client or member. Consent must be updated at least annually thereafter. For clients or members and their families who experience LEP or hearing impairment clients, providers must use qualified or certified health care interpreters when obtaining client or member consent;

…

Providers who offer telehealth delivery of services must meet the following requirements:

• Must hold an unencumbered Oregon license;
• Must be enrolled with the Authority as an Oregon Health Plan (OHP) provider, per OAR 410-120-1260;
• Must provide services using telehealth that are within their respective certification or licensing board’s scope of practice and comply with telehealth requirements including, but not limited to:
  • Documenting client or member and provider agreement of consent to receive services.
  • Allowed physical locations of provider and client or member.
  • Establishing or maintaining an appropriate provider-client or member relationship.

SOURCE: OR OAR 410-120-1990, Health Systems Division: Medical Assistance Programs, Telehealth. (Accessed Jul. 2025).

Teledentistry

A member receiving services through teledentistry must be notified of the right to receive interactive communication with the distant dentist and must receive an interactive communication with the distant dentist upon request.

The member’s chart documentation must reflect notification of the right to interactive communication with the distant site dentist.

SOURCE: OR OAR 410-123-1265, Health Systems Division: Medical Assistance Programs, Oregon Health Plan, Teledentistry. (Accessed Jul. 2025).

School Based Health Services

The Authority may reimburse school medical providers for covered School-Based Health Services (SBHS) delivered via telehealth that meet the following criteria:

• The covered telehealth service is provided to a child or young adult to the same extent that the service may be covered if it were provided in person;
• The school medical provider meets the following privacy and security standards:
  • Prior to the delivery of the covered service using a telemedicine or telehealth modality, the medically-qualified individual obtains written, oral, or recorded consent for the child or young adult to receive services using a telemedicine or telehealth delivery method. The medically-qualified individual must document oral consent. Documented or recorded consent must include:
    • That information regarding the service and delivery method was provided in the language that the child or young adult or the parent or legal guardian understands. Consent must also be in the understood language.
    • The medically-qualified individual’s assessment of the child or young adult’s ability to access and participate in telemedicine or telehealth delivered services.
  • Comply with the Health Insurance Portability and Accountability Act (HIPAA) of 1996; and
  • Comply with the Authority’s Privacy and Confidentiality Rules in OAR Chapter 943, Division 14 except as noted in section (4) below.
    • The medically-qualified individual may use synchronous audio and visual interactive technologies, including interactive audio/telephonic services provided to a child or young adult in a geographical area where synchronous audio and video is not available or consent for audio/video is refused for services provided to a child or young adult (see regulation for more).

SOURCE: OR OAR 410-133-0070, Health Systems Division: Medical Assistance Programs, School-Based Health Services, Telehealth (Accessed Jul. 2025).

Last updated 07/30/2025

Definitions

“Telemedicine” means the mode of delivering health services using information and telecommunication technologies to provide consultation and education or to facilitate diagnosis, treatment, care management or self-management of a patient’s health care.

SOURCE: OR Statute 414.723, (Accessed Jul. 2025).

“Telemedicine” means the mode of delivering remote clinical health services using information and telecommunication technologies to provide consultation and education or to facilitate diagnosis, treatment, care management or self-management of a client or member’s healthcare.

“Telehealth” includes telemedicine and includes the use of electronic information and telecommunications technologies to support remote clinical healthcare, client or member and professional health-related education, public health, and health administration.

“Telecommunication technologies” means the use of devices and services for telemedicine or telehealth delivered services. These technologies include videoconferencing, store-and-forward imaging, streaming media including services with information transmitted via landlines, and wireless communications, including the Internet and telephone networks.

SOURCE: OR OAR 410-120-1990, Health Systems Division: Medical Assistance Programs, Telehealth & 410-120-0000, [slight variations exist between the definitions], (Accessed Jul. 2025).

Rules for RHCare Clinics, Certification Requirements for CCare Clinics, Certification Requirements for AbortionCare clinics

“Telehealth” means the provision of healthcare remotely by means of telecommunications technology.

SOURCE: OR Admin Code 333-004-3010, (Accessed Jul. 2025).

Behavioral Health Services

“Telehealth” means a technological solution that provides two-way, video-like communication on a secure line.

SOURCE: OAR 309-032-0860, Health Systems Division: Medical Assistance Programs, Behavioral Health Services. (Accessed Jul. 2025).

Telemedicine encompasses different types of programs, services, and delivery mechanisms for medically appropriate covered services within the recipient’s benefit package.

SOURCE: OR OAR 410-172-0850, Health Systems Division: Medical Assistance Programs, Medicaid Payment for Behavioral Health Services, Telemedicine for Behavioral Health. (Accessed Jul. 2025).

 “Virtual Visit” means a visit between a patient and an approved visitor using computerized or video monitors, or telephones.

SOURCE: OR OAR 309-106-0005, Health Systems Division: Behavioral Health Services, Chapter 309, Division 106 Visitation of Patients and Residents in State Institutions.  (Accessed Jul. 2025).

Telehealth services include a variety of health services provided by synchronous or asynchronous electronic communications, including secure electronic health portal, audio, or audio and video and clinician-to-clinician virtual consultations.

SOURCE: Oregon Health Authority, Health Evidence Review Commission, Guideline Note Changes for the Jan. 1, 2025 Prioritized List of Health Services, p. AD-2. (1/1/25). (Accessed Jul. 2025).

Teledentistry can take multiple forms, both synchronous and asynchronous, including but not limited to:

• Live video, a two-way interaction between a member and dentist using audiovisual technology;
• Store and forward, an asynchronous transmission of recorded health information such as radiographs, photographs, video, digital impressions, or photomicrographs transmitted through a secure electronic communication system to a dentist, and it is reviewed at a later point in time by a dentist. The dentist at a distant site reviews the information without the member being present in real time;
• Remote member monitoring, where personal health and dental information is collected by dental care providers in one location then transmitted electronically to a dentist in a distant site location for use in care; and
• Mobile communication devices such as cell phones, tablet computers, or personal digital assistants that may support mobile dentistry, health care, public health practices, and education.

SOURCE: OR OAR 410-123-1265, Health Systems Division: Medical Assistance Programs, Oregon Health Plan, Teledentistry. (Accessed Jul. 2025).

School Based Health Services

“Telecommunication technologies” means the use of devices and services for telemedicine or telehealth delivered services. These technologies include, but are not limited to, videoconferencing, store-and-forward imaging, streaming media including services with information transmitted using landlines, and wireless communications, including the Internet and telephone networks.

“Telehealth” means the use of electronic information and telecommunications technologies, including telemedicine, to support remote clinical healthcare, client or member and professional health-related education, public health, and health administration.

“Telemedicine” means the mode of delivering remote clinical health services using information and telecommunication technologies to provide consultation and education or to facilitate diagnosis, treatment, care management or self-management of a client or member’s healthcare.

SOURCE: OR OAR 410-133-0040, Health Systems Division: Medical Assistance Programs, School-Based Health Services. (Accessed Jul. 2025).

The Behavioral Health Loan Repayment Program and Behavioral Health Care Bonus and Housing Stipend Incentive Program

“Telehealth” means the provision of health services from a distance using electronic communications.

SOURCE: OR Admin Rule 309-081-0010 and 309-083-0010, (Accessed Jul. 2025).

Health Care Provider Incentive Program

“Telehealth” means the provision of health services from a distance using electronic communications.

SOURCE: OR Admin Rule 409-036-0010, (Accessed Jul. 2025).

Aging and People with Disabilities and Developmental Disabilities

“Technology and Telehealth” means electronic or virtual means or methods, including but not limited to computer technology, web or internet access, social media, videoconferencing or other technological means or methods to improve resident social isolation and allow for the provision of virtual health care.

SOURCE: OR OAR 411-062-0010, (Accessed Jul. 2025).

Assertive Community Treatment (ACT) 

“Telehealth” means services that are delivered using secure HIPAA compliant audio and video communication. All allowable accommodations will be made for any individuals with any hearing, visual or physical impairments or disabilities who agree to utilize services in this manner per Medicaid compliance within OAR 410-120-1990 rule set.

SOURCE: 309-019-0225, Oregon Health Authority, Health Systems Division: Behavioral Health Services,  DACT Model (Accessed Jul. 2025).

Health Professional Student Clinical Training

“Telehealth” means the provision of health services where the patient and professional are not present in the same location but interact via technology.

SOURCE: 409-030-0110, Oregon Health Authority, Health Systems Division: Health Professional Student Clinical Training (Accessed Jul. 2025).

Last updated 07/30/2025

Email, Phone & Fax

“Audio only” means the use of audio technology, permitting real-time communication between a health care provider and a member for the purpose of diagnosis, consultation or treatment. “Audio only” does not include health services that are normally delivered by audio telephone technology and normally not billed as separate services by a health care provider, such as the sharing of laboratory results.

SOURCE: OAR 410-120-1990 (Accessed Jul. 2025).

 “Audio only” means the use of audio technology, permitting real-time communication between a health care provider and a member for the purpose of diagnosis, consultation or treatment. “Audio only” does not include health services that are customarily delivered by audio telephone technology and customarily not billed as separate services by a health care provider, such as the sharing of laboratory results.

SOURCE:  OR OAR 140-120-0000, Medical Assistance Program: Acronyms and Definitions, (Accessed Jul. 2025).

“Audio only” does not include:

• The use of facsimile, electronic mail or text messages.
• The delivery of health services that are customarily delivered by audio telephone technology and customarily not billed as separate services by a health care provider, such as the sharing of laboratory results.

To encourage the efficient use of resources and to promote cost-effective procedures in accordance with ORS 413.011 (Duties of board) (1)(L), the Oregon Health Authority shall reimburse the cost of health services delivered using telemedicine, including but not limited to:

• Health services transmitted via landlines, wireless communications, the Internet and telephone networks;
• Synchronous or asynchronous transmissions using audio only, video only, audio and video and transmission of data from remote monitoring devices; and
• Communications between providers or between one or more providers and one or more patients, family members, caregivers or guardians.

The authority shall pay the same reimbursement for a health service regardless of whether the service is provided in person or using any permissible telemedicine application or technology.

SOURCE: OR Revised Statutes Ch. 414.723, (Accessed Jul. 2025).

Covered telephonic and online services include services related to evaluation, assessment and management as well as other technology-based services (CPT 98966-98968, 99441-99443, 99421-99423, 98970-98972, G2012, G2061-G2063, G2251-G2252).

Covered telephone and online services billed using these codes do not include either of the following:

• Services related to a service performed and billed by the physician or qualified health professional within the previous seven days, regardless of whether it is the result of patient-initiated or physician-requested follow-up.
• Services which result in the patient being seen within 24 hours or the next available appointment.

Covered interprofessional consultations include consultations delivered online, through electronic health records or by telephone (CPT 99446-99449, 99451-99452).

SOURCE: Oregon Health Authority, Health Evidence Review Commission, Guideline Note Changes for the Jan. 1, 2025 Prioritized List of Health Services, p. AD-3. (1/1/25). (Accessed Jul. 2025).

“Asynchronous” means not simultaneous or concurrent in time. For the purpose of this rule, asynchronous telecommunication technologies for telemedicine or telehealth services may include audio and video, audio, or member portal and may include transmission of data from remote monitoring. “Asynchronous” does not include voice messages, facsimile, electronic mail or text messages.

“Telecommunication technologies” means the use of devices and services for telemedicine or telehealth delivered services. These technologies include video conferencing, store-and-forward imaging, streaming media including services with information transmitted using landlines, and wireless communications, including the Internet and telephone networks.

SOURCE: OR OAR 140-120-0000, Medical Assistance Program: Acronyms and Definitions; & OR OAR 410-120-1990[slight variation exists] (Accessed Jul. 2025).

Intent to Submit a State Plan Amendment:

The Authority reimbursement of patient to clinician telephonic and electronic services for established patients are based upon the maximum allowable fees are established using the CMS Resource Based Relative Value (RBRVS) methodology as published in the Federal Register annually with periodic updates, multiplied by the Oregon specific conversion factor. Oregon conversion factors as listed on Attachment 4.19-B, page 1 of this state plan.

Except as otherwise noted in the state plan, state developed fee schedule rates are the same for both governmental and private providers. The agency’s fee schedule rate was set as of 10/1/24 and is effective for services provided on or after that date. State-wide fee schedules are published on the agency’s web at https://www.oregon.gov/oha/HSD/OHP/Pages/Fee-Schedule.aspx

SOURCE:  Oregon Health Authority, Public Notice, July 31, 2024, (Accessed Jul. 2025).

Behavioral Health

Patient consultations using telephone and online or electronic mail (e-mail) are covered when billed services comply with the practice guidelines set forth by the Health Evidence Review Commission and the applicable HERC-approved code requirements, delivered consistent with the HERC Evidence-Based Guidelines;

Behavioral health services specifically identified as allowable for telephonic delivery are listed on the Behavioral Health Fee schedule published by the Authority.

Unless expressly authorized in OAR 410-120-1200 (Exclusions), other types of telecommunications are not covered such as images transmitted via facsimile machines and electronic mail when:

• Those methods are not being used in lieu of videoconferencing, due to limited videoconferencing equipment access; or
• Those methods and specific services are not specifically allowed pursuant to the Oregon Health Evidence Review Commission’s Prioritized List of Health Services and Evidence Based Guidelines.

SOURCE: OR OAR 410-172-0850, Health Systems Division: Medical Assistance Programs, Medicaid Payment for Behavioral Health Services, Telemedicine for Behavioral Health. (Accessed Jul. 2025).

Teledentistry

Mobile communication devices such as cell phones, tablet computers, or personal digital assistants that may support mobile dentistry, health care, public health practices, and education.

Unless authorized in OAR 410-120-1990, other types of telecommunications such as telephone calls, images transmitted via facsimile machines, and electronic mail are not covered

• The dentist may bill for teledentistry on the same type of claim form as other types of procedures unless in conflict with the Dental Services rules;
• All Dental Services rules, criteria, and limits apply to teledentistry services in the same manner as other services; and
• As stated in ORS 679.543 and this rule, payment for dental services may not distinguish between services performed using teledentistry, real time, or store-and-forward and services performed in-person.

SOURCE: OR OAR 410-123-1265, Health Systems Division: Medical Assistance Programs, Oregon Health Plan, Teledentistry. (Accessed Jul. 2025).

School Based Health Services

For school-based telehealth service claims:

• A service provided using synchronous audio and video must include modifier GT;
• A service provided using synchronous audio, without video, (e.g., telephone) must include modifier 93.

SOURCE: OR OAR 410-133-0070, Health Systems Division: Medical Assistance Programs, School-Based Health Services, Telehealth (Accessed Jul. 2025).

Indian Health Services

For the provision of services defined in Titles XIX and XXI and provided through an IHS or Tribal 638 facility, an “encounter” is defined as a face-to-face, telephone contact, or a prescription fill as defined in OAR 410-146-0085(8) between a health care professional and an eligible OHP client within a 24-hour period ending at midnight, as documented in the client’s medical record. Section (7) of this rule outlines limitations for telephone contacts that qualify as encounters. For purposes of this rule, face-to-face “encounter” includes services provided via a synchronous two-way audiovisual link between a patient and a provider per 410-130-0610.

Telephone encounters qualify as a valid encounter for services provided in accordance with OAR 410-130-0595, Maternity Case Management; OAR 410-146-0200, Tribal Pharmacy; and OAR 410-130-0190, Tobacco Cessation (OAR 410-120-1200). Except as set forth below, Providers may not make telephone contacts at the exclusion of face-to-face visits.

• Telephone encounters must include all the same components of the service as if provided face-to-face.
• During a state of emergency of an epidemic outbreak of an infectious disease impacting the safety of public health, in accordance with the Health Evidence Review Commission’s Prioritized List, guideline notes, and OAR 410-130-0610 (for dates of service on or before December 31, 2020) and OAR 410-120-1990 (for dates of service on or after January 1, 2021), telephonic evaluation management services, assessment and management services, and psychotherapy are appropriate to ensure access to care while avoiding and preventing unnecessary potential infectious exposure, and may be made in place of a face-to-face visit.

SOURCE: OR OAR 410-146-0085, Health Systems Division: Medical Assistance Programs American Indian/Alaska Native.  (Accessed Jul. 2025).

Federally Qualified Health Center and Rural Health Clinics

For the provision of services defined in Titles XIX and XXI and provided through an FQHC or RHC, an “encounter” is defined as a face-to-face or telephone contact between a health care professional and an eligible OHP client within a 24-hour period ending at midnight, as documented in the client’s medical record. Section (4) of this rule outlines limitations for telephone contacts that qualify as encounters. For purposes of this rule, a face-to-face “encounter” includes services provided via a synchronous two-way audiovisual link between a patient and a provider per OAR 410-130-0610.

Telephone encounters qualify as a valid encounter for services provided in accordance with OAR 410-130-0595, Maternity Case Management (MCM) and 410-130-0190, Tobacco Cessation (see also OAR 410-120-1200). Except as set forth below, providers may not make telephone contacts at the exclusion of face-to-face visits.

• Telephone encounters must include all the same components of the service as if provided face-to-face.
• During a state of emergency of an epidemic outbreak of an infectious disease impacting the safety of public health, in accordance with the Health Evidence Review Commission’s Prioritized List, guideline notes, and OAR 410-130-0610 (for dates of service on or before December 31, 2020) and OAR 410-120-1990 (for dates of service on or after January 1, 2021), telephonic evaluation management services, assessment and management services, and psychotherapy are appropriate to ensure access to care while avoiding and preventing unnecessary potential infectious exposure, and may be made in place of a face-to-face visit.

SOURCE: OR OAR 410-147-0120, Healthy Systems Division: Medical Assistance Programs, Federally Qualified Health Center and Rural Health Clinics Services.  (Accessed Jul. 2025).

Last updated 07/30/2025

Live Video

POLICY

To encourage the efficient use of resources and to promote cost-effective procedures in accordance with ORS 413.011 (Duties of board) (1)(L), the Oregon Health Authority shall reimburse the cost of health services delivered using telemedicine, including but not limited to:

• Health services transmitted via landlines, wireless communications, the Internet and telephone networks;
• Synchronous or asynchronous transmissions using audio only, video only, audio and video and transmission of data from remote monitoring devices; and
• Communications between providers or between one or more providers and one or more patients, family members, caregivers or guardians.

The authority shall pay the same reimbursement for a health service regardless of whether the service is provided in person or using any permissible telemedicine application or technology.

SOURCE: OR Statute 414.723. (Accessed Jul. 2025).

“Synchronous” means an interaction between a provider and a client or member that occurs at the same time using an interactive technology. This may include audio only, video only, or audio with video and may include remote monitoring. Synchronous encounters are considered to meet face-to-face requirements.

Privacy and security standards for telehealth services must be met by satisfying the following:

• Prior to the delivery of services using a telehealth modality, a client or member’s written, oral, or recorded consent to receive services using a telehealth delivery method in the language that the client or member understands must be obtained and documented by the health system, clinic or provider in the client or member’s health record. Consent must include an assessment of client or member readiness to access and participate in telehealth delivered services, including conveying all other options for receiving the health care service to the client or member. Consent must be updated at least annually thereafter. For clients or members and their families who experience LEP or hearing impairment clients, providers must use qualified or certified health care interpreters when obtaining client or member consent;
• Consistent with Oregon Revised Statute (ORS) 109.640, provision of birth control information and services using a  telehealth modality must be provided to any person regardless of age without consent of parent or legal guardian;
• Consistent with ORS 109.640, provision of any other medical or dental diagnosis and treatment using a telehealth modality must be provided to any person 15 years of age or older without consent of parent or legal guardian;
• Consistent with ORS 109.675, provision of outpatient diagnosis or treatment of a mental or emotional disorder or a chemical dependency using a telehealth modality must be provided to any person 14 years of age or older without consent of parent or legal guardian;
• Consistent with ORS 109.610, provision of diagnosis or treatment of certain sexually transmitted infections using a telehealth modality must be provided to a person regardless of age without consent of parent or legal guardian;
• Services provided using a telehealth platform must comply with Health Insurance Portability and Accountability Act (HIPAA), https://aspe.hhs.gov/report/health-insurance-portability-and-accountability-act-1996, and with the Authority’s Privacy and Confidentiality Rules (chapter 943, division 14) except as noted in section (10) below;
• There is no limitation on the location of the client or member;
• OHP enrolled providers may be located in any location where client or member privacy and confidentiality can be ensured;
• Persons providing interpretive services and supports must be in a location where client or member privacy and confidentiality can be ensured.

When allowed by individual certification or licensing board’s scope of practice standards, qualifying  telehealth delivered services are covered:

• When provided to established clients or members;
• When provided to new clients or members; and
• When consistent with applicable program specific OARs within chapter 410.

In the event of a declared emergency or changes in federal requirements, the Authority may adopt flexibilities to remove administrative barriers and support telehealth delivered services:

• The Authority must follow guidance from the US Department of Health and Human Services (HHS) Office for Civil Rights (OCR), which may allow enforcement discretion related to privacy or security requirements.
• The Authority may expand network capacity through remote care and telehealth services provided across state lines.
• The Authority may exercise flexibilities in network adequacy requirements as described in OAR 410-141-3515.

SOURCE: OAR 410-120-1990 Health Systems Division: Medical Assistance Programs, Telehealth. (Accessed Jul. 2025).

Patient consultations using videoconferencing, a synchronous (live two-way interactive) video transmission resulting in real time communication between a provider located in a distant site and the recipient being evaluated and located in an originating site, is covered when billed services comply with the billing requirements. See OAR for billing requirements.

SOURCE: OR OAR 410-172-0850, Health Systems Division: Medical Assistance Programs, Medicaid Payment for Behavioral Health Services, Telemedicine for Behavioral Health. (Accessed Jul. 2025).

Communications may be between providers, or between one or more providers and one or more clients or members, family members, caregivers and guardians.

CCOs and FFS providers must ensure Oregon Health Plan (OHP) clients or members are offered a choice of how services are received, including services offered using telehealth modalities and in-person services, except where the Authority issues explicit guidance during a declared state of emergency or if a facility has implemented its facility disaster plan.

SOURCE:  OAR 410-120-1990 Health Systems Division: Medical Assistance Programs, Telehealth. (Accessed Jul. 2025).

The Oregon Health Authority (OHA) will submit a Medicaid State Plan Amendment to the Centers for Medicare & Medicaid Services (CMS) to change from the flat telehealth rates used during the COVID-19 Public Health Emergency (PHE) to rates based on Relative Value Units (RVUs) multiplied by the Oregon conversion factor.  See memo for a table that lists the current PHE rate and the proposed RVU-based rate for covered telehealth codes.

SOURCE: Oregon Health Authority, Notice of intent – OHA will amend the Medicaid State Plan to increase rates for telehealth services.  Public Notice, May 18, 2023, (Accessed Jul. 2025).

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ELIGIBLE SERVICES/SPECIALTIES

CCOs and FFS providers must ensure Oregon Health Plan (OHP) clients or members are offered a choice of how services are received, including services offered using telehealth modalities and in-person services, except where the Authority issues explicit guidance during a declared state of emergency or if a facility has implemented its facility disaster plan.

Providers unable to offer in-person services:

• FFS providers unable to offer in-person services must develop, maintain and carry out policies and procedures to offer local provider options to a client or member when an in-person visit is clinically indicated or when the client or member requests in-person services. This may include but is not limited to care coordination or completing referral paperwork;
• CCOs must ensure that providers unable to offer in-person services have access to the CCO Provider Directory.  CCOs must include in applicable provider contract language that providers unable to offer in-person services shall, as needed, inform the CCO upon referring a member to another provider so the CCO can provide any care coordination services necessary to support the member in accessing care.

Client or member choice and accommodation for telehealth must encompass the following standards and services:

• Providers who offer telehealth delivered services must offer meaningful access to services by completing a capacity assessment of the client or member in the use of specific approved methods of telehealth delivery that comply with accessibility standards including alternate formats, and provides the optimal quality of care for the client or member given considerations of client or member access to necessary devices, access to a private and safe location, adequate internet, digital literacy, cultural appropriateness of services delivered using telehealth, and other considerations of client or member readiness to use telehealth;
• Providers must offer meaningful access to health care services for clients or members and their families who experience Limited English Proficiency (LEP) or hearing impairment by working with qualified or certified health care interpreters, to provide language access services as described in OAR 333-002-0040. These services must not be significantly restricted, delayed, or inferior as compared to programs or activities provided to English proficient individuals;
• Providers must collaborate with clients or members to identify and offer modalities for delivering health care services which best meets the needs of the member and considers the client or member’s choice and readiness for the modality of service selected;
• Providers must offer telehealth services which are consistent with “meaningful access” as defined in OAR 410-120-0000.

See rule for privacy and security standards.

CCOs and the Authority will reimburse telehealth delivered services only when all the following requirements are met:

Services provided must be covered services according to the client or member’s benefit package as described in OAR 410-120-1210 and be provided in a manner compliant with relevant guideline notes included in the Health Evidence Review Commission’s Prioritized List of Health Services as described in OAR 410-141-3830;

CCOs and the Authority must provide reimbursement for telehealth services at the same reimbursement rate as if the professional services were provided in person.

SOURCE: OAR 410-120-1990, Health Systems Division: Medical Assistance Programs, Telehealth. (Accessed Mar. 2025).

Teledentistry

Teledentistry can take multiple forms, both synchronous and asynchronous, including but not limited to:

• Live video, a two-way interaction between a member and dentist using audiovisual technology;
• Store and forward, an asynchronous transmission of recorded health information such as radiographs, photographs, video, digital impressions, or photomicrographs transmitted through a secure electronic communication system to a dentist, and it is reviewed at a later point in time by a dentist. The dentist at a distant site reviews the information without the member being present in real time;
• Remote member monitoring, where personal health and dental information is collected by dental care providers in one location then transmitted electronically to a dentist in a distant site location for use in care; and
• Mobile communication devices such as cell phones, tablet computers, or personal digital assistants that may support mobile dentistry, health care, public health practices, and education.

All Dental Services rules, criteria, limits, and billing requirements apply to teledentisry services in the same manner as other services.

General Billing Requirements:

• Unless authorized in OAR 410-120-1990, other types of telecommunications such as telephone calls, images transmitted via facsimile machines, and electronic mail are not covered;
• The dentist may bill for teledentistry on the same type of claim form as other types of procedures unless in conflict with the Dental Services rules;
• All Dental Services rules, criteria, and limits apply to teledentistry services in the same manner as other services; and
• As stated in ORS 679.543 and this rule, payment for dental services may not distinguish between services performed using teledentistry, real time, or store-and-forward and services performed in-person.

SOURCE: OR OAR 410-123-1265, Health Systems Division: Medical Assistance Programs, Oregon Health Plan, Teledentistry. (Accessed Jul. 2025).

Behavioral Health

For purposes of behavioral health services, the Authority shall provide coverage for telemedicine services to the same extent that the services would be covered if they were provided in person.

SOURCE: OR OAR 410-172-0850, Health Systems Division: Medical Assistance Programs, Medicaid Payment for Behavioral Health Services, Telemedicine for Behavioral Health, (Accessed Jul. 2025).

Behavioral Health Resource Networks

A comprehensive BHRN must include at minimum the required services below to be funded by the OAC. These services may be provided by one or more entities who refer between and collaborate with each other. To be a BHRN, a BHRN must provide, and maintain sufficient capacity to provide, the following services and supports to individuals who use substances that cause harm or have a substance use disorder in the BHRN’s county or region:

• Screening must be conducted by PSS, CRM, PWS or other addiction professional. Screening service must be available 24 hours a day, seven days a week, every calendar day of the year. Screening must be made available to each individual immediately upon first contact. At least one organization within each BHRN within each county or region must meet this requirement: …
  • Services must be offered face-to-face or through telehealth. The modality must be based on the needs and preference of the individual as well as any safety concerns identified by the individual or the BHRN.

See rule for additional information.

SOURCE: OR OAR 944-001-0020, Oversights and Accountability Council, Behavioral Resource Networks, (Accessed Jul. 2025). 

Behavioral Rehabilitation Services Program

To utilize telehealth for services required by the BRS program, the BRS contractor and BRS providers shall:

• Comply with Telehealth for Behavioral Health requirements described in OAR 410-172-0850;
• Comply with prioritized list of health services guidelines for telephone and e-mail consultation described in OAR 410-141-3830; and
• Comply with agency specific BRSTelehealth  program rules and policies.

The BRS contractor and BRS providers shall develop written telehealth policy that complies with section (4)(a)(A-C) of this rule. At minimum, the policy shall describe:

• The circumstances the provider may provide BRS services via telehealth;
• The telecommunication technologies the BRS contractor or BRS provider has implemented to deliver services via telehealth; and
• The process to obtain an individual’s informed consent in accordance with ORS 107.154, 179.505, 179.507, 192.515, including a sample form.

The BRS contractor and BRS providers may utilize telehealth for services that require a face-to-face setting when there is a documented barrier to providing in-person services, as follows:

• Services via telehealth shall be provided by a qualified program staff within their scope of position;
• Service notes for phone, individual or group counseling shall follow the same criteria as face-to-face counseling and identify the session was conducted by telehealth and the reason for the use of telehealth; and
• Individual or group counseling via telehealth shall meet HIPAA and 42 CFR Part 2 standards for privacy.

School Based Health Services

The Authority may reimburse school medical providers for covered School-Based Health Services (SBHS) delivered via telehealth that meet the following criteria:

• The covered telehealth service is provided to a child or young adult to the same extent that the service may be covered if it were provided in person;
• The school medical provider meets the following privacy and security standards (see regulation)

The Authority shall provide reimbursement for a Medicaid-covered school-based telehealth service at the same reimbursement rate as if the service were provided in person.

For school-based telehealth service claims:

• A service provided using synchronous audio and video must include modifier GT;
• A service provided using synchronous audio, without video, (e.g., telephone) must include modifier 93.

In the event of a national or state declaration of emergency or in a prolonged school closure due to crisis, pandemic, or disaster, the Authority may modify the requirements for telehealth services to facilitate delivery of medically necessary service delivery. Modifications include, but are not limited to:

• Recognizing that exceptional circumstances may affect how all educational and related services and supports are provided, the Authority shall, to the extent possible based on the exceptional circumstance, follow guidance from the US Department of Health and Human Services (HHS), Office for Civil Rights (OCR), Office of Special Education Programs (OSEP) in the Department of Education, and Office of Special Education and Rehabilitative Services (OSERS) and may allow enforcement discretion related to encryption requirements; and
• The Authority may reimburse a SBHS delivered using a telehealth platform if:
  • The telehealth service is medically necessary and appropriate;
  • The delivery of the telehealth service reasonably approximates an in-person service; and
  • Access to the telehealth service shall reduce barriers in the delivery of the health care service to accommodate the child or young adult’s Individual Plan of Care (IPOC).

SOURCE: OR OAR 410-133-0070, Health Systems Division: Medical Assistance Programs, School-Based Health Services, Telehealth (Accessed Jul. 2025).

Reproductive Health Access Program

Covered services provided by telehealth technology may be billed to the RH Program, as appropriate. The CVR must indicate that the visit was conducted via telehealth. All telehealth visits must adhere to applicable state and federal telehealth regulations.

SOURCE: OR OAR 333-004-3110, RH Access Fund Billing and Claims (Accessed Jul. 2025).

Newborn Nurse Home Visiting Service Requirements

If a family declines home visiting services in their home, an alternate location may be offered, and telemedicine services must be offered and delivered in accordance with ORS 743A.058. Declination of home visiting services in the home must be documented in the client’s medical record.

SOURCE: OAR 333-006-0120, Health Systems Division: Public Health Division, Universally Offered Newborn Nurse Home Program, (Accessed Jul. 2025).

Health benefit plans must reimburse at the case rate for newborn nurse home visiting services conducted via telemedicine pursuant to OAR 333-006-0120 and ORS 743A.058.

SOURCE: OAR 333-006-0190, Health Systems Division: Public Health Division, Universally Offered Newborn Nurse Home Program, (Accessed Jul. 2025).

1915(i) Home and Community Based Services State Plan Option

“Face-to-Face” means a personal interaction where both words can be heard and facial expressions can be seen, either in person or through telehealth services where there is a live streaming audio and video, if medically appropriate and necessary. Face-to-face could include communication methods such as telehealth/telemedicine, in lieu of in-person visits, in accordance with HIPAA, as directed by OHA and as chosen by the Individual. Medically appropriate and necessary accommodations shall be made for Individuals with disabilities including those with hearing or sight impairments. For telehealth the following conditions must be met:

• The agent performing the assessment is independent and qualified as defined in 42 CFR 441.730 and meets the provider qualifications defined by the State, including any additional qualifications or training requirements for the operation of required information technology.
• The Individual receives appropriate support during the assessment, including the use of any necessary on-site support-staff.
• The Individual provides informed consent for this type of assessment.

Eligibility for 1915(i) HCBS is established through a diagnostic and  face-to-face needs-based assessment by an external IQA who meets the requirements of a QMHP:

• Telehealth is considered face-to-face and it is the Individuals choice to conduct the assessment in- person or via telehealth;
• In-Person or telehealth options are based on the choice and preference of the Individual accessing HCBS;
• Individuals who choose telehealth assessment options must schedule an in-person follow up meeting within ninety (90) days of the functional needs assessment.

See regulation for additional requirements.

SOURCE: OAR 410-173-0005 & 410-173-0010, Oregon Health Authority, Health Systems Division: Medical Assistance Programs,  1915(i) Home and Community Based Services State Plan Option (Accessed Jul. 2025).

Durable Medical Equipment

For initial ordering of DME items identified in section (9) of this rule, an in-person or telehealth face-to-face encounter that is related to the primary reason the client requires the medical equipment or supplies must occur no more than six months prior to the start of services.

Telehealth encounters used to satisfy the face-to-face encounter requirement for a DMEPOS item must meet the requirements outlined in the HERC Ancillary Guideline note A5.

SOURCE: 410-122-0090, Oregon Health Authority, Health Systems Division: Medical Assistance Programs,  Durable Medical Equipment Program Rules (Accessed Jul. 2025).

Assertive Community Treatment (ACT) 

“Community-Based” means services and supports that must be provided in a participant’s home and/or surrounding community. This can include but not limited to virtual telehealth, or in the community wherethe participant feels most comfortable. This is person-centered and will be tailored to the participants discretion.

“Face to Face” means that a personal interaction where communication between at least two-person(s) can be had either in-person or virtually through telehealth services per Medicaid OAR 410-120-1990 rule set. Virtual Telehealth meetings for Face-to-Face therapy fidelity measurement purposes will be counted and accepted as face-to-face as long as documentation supports the meeting followed Medicaid standards cited within this definition.

SOURCE: 309-019-0225, Oregon Health Authority, Health Systems Division: Behavioral Health Services,  DACT Model (Accessed Jul. 2025).

Behavioral Health Services – IPS

“Face to Face” means that a personal interaction where communication between at least two-person(s) can be had. This will include any interactions through telehealth services where there is secured Health Insurance Portability and Accountability (HIPAA) approved live streaming audio and video. Virtual Telehealth meetings for Face-to-Face fidelity measurement purposes will be a last resort option if in-person is not safely available or feasible.

SOURCE: 309-019-0270, Oregon Health Authority, Health Systems Division: Behavioral Health Services,  (Accessed Jul. 2025).

Hospital Services

Caring contacts may be conducted in person, via telemedicine or by phone.

SOURCE: OAR 333-520-0070 Oregon Health Authority, Health Systems Division, Public Health Division, Emergency Department and Emergency Services.  (Accessed Jul. 2025).

IIBHT Entry, Assessment and Engagement

A Service Plan shall be completed in accordance with  OAR 309-019-0140, in collaboration with the youth/young adult and their family and additionally: …

• Locations and time preferences for service delivery, convenient to the youth/young adult and their family. Telehealth may be utilized when requested by the youth/young adult and their family but shall not be the primary mode of service delivery.

SOURCE: 309-021-0160, Oregon Health Authority, Health Systems Division: Behavioral Health Services,  (Accessed Jul. 2025).

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ELIGIBLE PROVIDERS

School-Based Health Services required by the Individuals with Disabilities Education Act (IDEA), Section 504 Plan, under the Rehabilitation Act of 1973, or any other documented individualized health or behavioral health plan or as otherwise determined medically necessary provided in school programs and settings provided to eligible children in their education program settings by public education enrolled providers billing for these services to Medicaid are exempt from this rule. See chapter 410, division 133 for School-Based Health Services OARs.

CCOs and FFS providers must ensure Oregon Health Plan (OHP) clients or members are offered a choice of how services are received, including services offered using telehealth modalities and in-person services, except where the Authority issues explicit guidance during a declared state of emergency or if a facility has implemented its facility disaster plan.

Providers unable to offer in-person services:

• FFS providers unable to offer in-person services must develop, maintain and carry out policies and procedures to offer local provider options to a client or member when an in-person visit is clinically indicated or when the client or member requests in-person services. This may include but is not limited to care coordination or completing referral paperwork;
• CCOs must ensure that providers unable to offer in-person services have access to the CCO Provider Directory.  CCOs must include in applicable provider contract language that providers unable to offer in-person services shall, as needed, inform the CCO upon referring a member to another provider so the CCO can provide any care coordination services necessary to support the member in accessing care.

Providers who offer telehealth delivery of services must meet the following requirements:

• Must hold an unencumbered Oregon license;
• Must be enrolled with the Authority as an Oregon Health Plan (OHP) provider, per OAR 410-120-1260;
• Must provide services using telehealth that are within their respective certification or licensing board’s scope of practice and comply with telehealth requirements including, but not limited to:
  • Documenting client or member and provider agreement of consent to receive services.
  • Allowed physical locations of provider and client or member.
  • Establishing or maintaining an appropriate provider-client or member relationship.
• Comply with HIPAA and the Authority’s Privacy and Confidentiality Rules and security protections for the member in connection with the telehealth communication and related records requirements (OAR chapter 943 division 14 and 120, OAR 410-120-1360 and 1380, 42 CFR Part 2, if applicable, and ORS 646A.600 to 646A.628 (Oregon Consumer Identity Theft Protection Act) except as noted in section (10) of this rule;
• Obtain and maintain technology used in telehealth communication that is compliant with privacy and security standards in HIPAA and the Authority’s Privacy and Confidentiality Rules described in subsection (A) except as noted in section (10) of this rule;
• Develop and maintain policies and procedures to prevent a breach in privacy or exposure of client or member health information or records (whether oral or recorded in any form or medium) to unauthorized persons and timely breach reporting as described in OAR 943-014-0440;
• Maintain clinical and financial documentation related to telehealth services as required in OAR 410-120-1360 and any program specific rules in OAR chapter 309 and chapter 410;
• Comply with all federal and state statutes as required in OAR 410-120-1380.

As a condition of reimbursement, FFS providers must agree to reimburse Certified and Qualified Health Care Interpreters (HCIs) as defined in OAR 333-002-0010 for interpretation services provided using telehealth at the same rate, excluding travel expenses, as if interpretation services were provided in-person.

CCOs must also reimburse Certified and Qualified HCIs for interpretation services provided using telehealth at the same reimbursement rate, excluding travel expenses, as if it were provided in person. These requirements do not supersede the CCOs direct agreement(s) with providers, including but not limited to, alternative payment methodologies, quality and performance measures or Value Based Payment methods described in the CCO contract. Administrative rules and CCO Direct Agreements do not supersede any federal or state requirements with regard to the provision and coverage of health care interpreter services.

All claim types except dental services must include modifier 95 when the telehealth delivered service utilizes a real-time interactive audio and video telecommunication system. When provision of the same service utilizes a real-time interactive audio only, the claim must include modifier 93.

SOURCE:  OAR 410-120-1990, Health Systems Division: Medical Assistance Programs, Telehealth. (Accessed Mar. 2025).

“Meaningful access” means client or member-centered access reflecting the following statute and standards:

• Pursuant to Title VI of the Civil Rights Act of 1964, Section 1557 of the Affordable Care Act and the corresponding Federal Regulation at 45 CFR Part 92 and The Americans with Disabilities Act (ADA), providers’ telemedicine or telehealth services shall accommodate the needs of individuals who have difficulty communicating due to a medical condition, who need accommodation due to a disability, advanced age or who have Limited English Proficiency (LEP) including providing access to auxiliary aids and services as described in 45 CFR Part 92;
• National Culturally and Linguistically Appropriate Services (CLAS) Standards at https://thinkculturalhealth.hhs.gov/clas/standards; and
• As applicable to the client or member, Tribal based practice standards: https://www.oregon.gov/OHA/HSD/AMH/Pages/EBP.aspx;
•  “Synchronous” means an interaction between a provider and a client or member that occurs at the same time using an interactive technology. This may include audio only, video only, or audio with video and may include remote monitoring.

SOURCE: OR OAR 140-120-0000, Medical Assistance Program: Acronyms and Definitions & OAR 410-120-1990, Health Systems Division: Medical Assistance Programs, Telehealth [refers to 410-120-0000]. (Accessed Jul. 2025).

Billing Provider Requirements, as referenced in OAR 410-120-1990:

• Dentists providing Medicaid services must be licensed to practice dentistry within the State of Oregon or within the contiguous area of Oregon and must be enrolled as provider with the Authority;
• Providers billing for covered teledentistry/telehealth services are responsible for the following:
  • Complying with Health Insurance Portability and Accountability Act (HIPAA) and Oregon Health Authority (OHA) Confidentiality and Privacy Rules and security protections for the patient in connection with the telemedicine communication and related records (Refer to OAR 410-120-1990);
  • Obtaining and maintaining technology used in the telehealth communication that is compliant with privacy and security standards in HIPAA and Department Privacy and Confidentiality Rules described in subsection (1) of this rule;
  • Ensuring policies and procedures are in place to prevent a breach in privacy or exposure of member health information or records (whether oral or recorded in any form or medium) to unauthorized individuals; and
  • Maintaining clinical and financial documentation related to telehealth services as required in OAR 410-120-1360 and OAR 410-120-1990.
• A member receiving services through teledentistry must be notified of the right to receive interactive communication with the distant dentist and must receive an interactive communication with the distant dentist upon request;
• The member’s chart documentation must reflect notification of the right to interactive communication with the distant site dentist; and
• A member may request to have real time communication with the distant dentist at the time of the visit or within thirty (30) days of the original visit.

The dentist who completes diagnosis and treatment planning and the oral evaluation also documents these services using the traditional Current Dental Terminology (CDT) codes. This provider also reports the teledentistry event using D9995 or D9996 as appropriate (See the Dental Billing Instructions for details at: www.oregon.gov/oha/HSD/OHP/Pages/Policy-Dental.aspx)

SOURCE: OR OAR 410-123-1265, Health Systems Division: Medical Assistance Programs, Oregon Health Plan, Teledentistry. (Accessed Jul. 2025).

See rule for requirements for providers billing behavioral health services.

SOURCE: OAR 410-172-0850, Health Systems Division: Medical Assistance Programs, Medicaid Payment for Behavioral Health Services, Telemedicine for Behavioral Health). (Accessed Jul. 2025).

School Based Health Services

The Authority may reimburse school medical providers for covered School-Based Health Services (SBHS) delivered via telehealth that meet the following criteria:

• The covered telehealth service is provided to a child or young adult to the same extent that the service may be covered if it were provided in person;
• The school medical provider meets the following privacy and security standards (see regulation)

The Authority shall provide reimbursement for a Medicaid-covered school-based telehealth service at the same reimbursement rate as if the service were provided in person.

For school-based telehealth service claims:

• A service provided using synchronous audio and video must include modifier GT;
• A service provided using synchronous audio, without video, (e.g., telephone) must include modifier 93

SOURCE: OR OAR 410-133-0070, Health Systems Division: Medical Assistance Programs, School-Based Health Services, Telehealth (Accessed Jul. 2025).

Dental Care Benefits for Pregnant Individuals

Pregnant members shall be seen, treated in person or via teledentistry for an OHP-covered service within the following time frames:

• For emergency dental care: within 24 hours;
• For urgent dental care: within one week.
• For routine dental care: within four weeks, unless there is a documented special clinical reason that would make access longer than four weeks appropriate;
• For initial dental screening or examination: four weeks.

Additional Dental Services are available to pregnant members if authorized as medically/Dentally Necessary due to the pregnancy. See regulation for more details.

SOURCE: OAR 410-123-1510, Health Systems Division: Medical Assistance Programs, Dental/Denturist Services. (Accessed Jul. 2025).

Behavioral Health Treatment Intake, Assessment and Service Planning 

All providers shall develop and implement written service delivery policies and specific procedures for office- based, community-based and telehealth services and supports compliant with these rules, to be made available to individuals and family members upon request (see rule for minimum requirements).

SOURCE: OAR 309-019-0110, Health Systems Division: Medical Assistance Programs, Outpatient Behavioral Health Services. (Accessed Jul. 2025).

Newborn Nurse Home Visiting Provider Requirements

Certified providers shall develop and implement policies and procedures regarding provider operations, including but not limited to:…

• Providing services by telemedicine.

Certified providers must: …

• Provide support telephone calls after the comprehensive newborn nurse home visit to ensure community connections are established.

Comprehensive newborn nurse home visits must: …

• Be provided in the family’s home, at an alternative location, or via telemedicine services per ORS 333-006- 0120(8).

If a family declines home visiting services in their home, an alternate location may be offered, and telemedicine services must be offered and delivered in accordance with ORS 743A.058. Declination of home visiting services in the home must be documented in the client’s medical record.

Health benefit plans must reimburse at the case rate for newborn nurse home visiting services conducted via telemedicine pursuant to OAR 333-006-0120 and ORS 743A.058.

SOURCE: Health Systems Division: Medical Assistance Programs, Outpatient Behavioral Health Services, OAR 333-006-0110;  333-006-0120; & 333-006-0190 (Accessed Jul. 2025).

If a QMHP is not part of the two-person MCIT in person, a QMHP must be available to respond when clinically indicated, either by telehealth or in person.

If the individual is located in a hospital, the initial crisis response may be provided in person by one mobile crisis intervention staff who meets the following criteria:

• A trained Qualified Mental Health Professional (QMHP), or a
• Trained Qualified Mental Health Associate (QMHA)
• If a QMHP is not sent in person, a QMHP must be available to respond when clinically indicated, either by telehealth or in person.

SOURCE:  OR Health Authority, Health Systems Division: Behavioral Health Services, Mobile Crisis Intervention Services and Stabilization Services, Sec. 309-072-0140, (Accessed Jul. 2025).

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ELIGIBLE SITES

There is no limitation on the location of the client or member;

OHP enrolled providers may be located in any location where client or member privacy and confidentiality can be ensured;

Persons providing interpretive services and supports must be in a location where client or member privacy and confidentiality can be ensured.

All physical, behavioral and dental telehealth services except School Based Health Services (SBHS) must include Place of Service code 02 when the client or member is located in a place other than their home. When the client or member is located in their home, the claim must include Place of Service code 10;

SOURCE: OAR 410-120-1990 Health Systems Division: Medical Assistance Programs, Telehealth. (Accessed Mar. 2025).

The authority shall include the costs of telemedicine services in its rate assumptions for payments made to clinics or other providers on a prepaid capitated basis.

SOURCE: OR Statute Ch. 414.723, (Accessed Jul. 2025).

The originating site may bill a CDT code only if a separately identifiable service is performed within the scope of practice of the practitioner providing the service. The service must meet all criteria of the CDT code billed.

SOURCE: OR OAR 410-123-1265, Health Systems Division: Medical Assistance Programs, Oregon Health Plan, Teledentistry. (Accessed Jul. 2025).

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GEOGRAPHIC LIMITS

Medical Assistance Benefits: Out of State Services

The division may not provide any payments for items or services to any financial institution or entity located outside of the United States pursuant to 1902(a)(80) of the Social Security Act.

This provision also prohibits payments to telemedicine providers and pharmacies located outside of the United States.

SOURCE: OR OAR 410-120-1180 Health Systems Division: Medical Assistance Programs Chapter 10. (Accessed Jul. 2025).

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FACILITY/TRANSMISSION FEE

The originating site code Q3014 is covered only when the patient is present in an appropriate health care setting and receiving services from a provider in another location.

SOURCE: Oregon Health Authority, Health Evidence Review Commission, Guideline Note Changes for the Jan. 1, 2025 Prioritized List of Health Services, p. AD-3. (1/1/25). (Accessed Jul. 2025).

Costs for telehealth technologies used to provide SBHS are included in the cost for each service discipline and are not billed separately.

SOURCE: OR OAR 410-133-0245 Health Systems Division: Medical Assistance Program – Chapter 410. (Accessed Jul. 2025).

Last updated 07/30/2025

Miscellaneous

Teledentistry

Providers billing for covered teledentistry/telehealth services are responsible for the following:

• Complying with Health Insurance Portability and Accountability Act (HIPAA) and Oregon Health Authority (OHA) Confidentiality and Privacy Rules and security protections for the patient in connection with the telemedicine communication and related records (Refer to OAR 410-120-1990);
• Obtaining and maintaining technology used in the telehealth communication that is compliant with privacy and security standards in HIPAA and Department Privacy and Confidentiality Rules described in subsection (1) of this rule;
• Ensuring policies and procedures are in place to prevent a breach in privacy or exposure of member health information or records (whether oral or recorded in any form or medium) to unauthorized individuals; and
• Maintaining clinical and financial documentation related to telehealth services as required in OAR 410-120-1360 and OAR 410-120-1990.

A member receiving services through teledentistry shall be notified of the right to receive interactive communication with the distant dentist and shall receive an interactive communication with the distant dentist upon request;

A member receiving services through teledentistry must be notified of the right to receive interactive communication with the distant dentist and must receive an interactive communication with the distant dentist upon request;

A member may request to have real time communication with the distant dentist at the time of the visit or within 30 days of the original visit.

The member’s chart documentation must reflect notification of the right to interactive communication with the distant site dentist; and

A member may request to have real time communication with the distant dentist at the time of the visit or within thirty (30) days of the original visit.

SOURCE: OR OAR 410-123-1265, Health Systems Division: Medical Assistance Programs, Oregon Health Plan, Teledentistry. (Accessed Jul. 2025).

Network Adequacy

MCEs shall have an access plan that establishes a protocol for monitoring and ensuring access, outlines how provider capacity is determined, and establishes procedures for monthly monitoring of capacity and access and for improving access and managing access in times of reduced participating provider capacity. The access plan and associated monitoring protocol shall address the following: …

• The availability of telemedicine within the MCE’s contracted provider network.

SOURCE: OAR 410-141-3515 Health Systems Division: Medical Assistance Programs, Oregon Health Plan, Network Adequacy. (Accessed Jul. 2025).

“Meaningful access” means client or member-centered access reflecting the following statute and standards:

• Pursuant to Title VI of the Civil Rights Act of 1964, Section 1557 of the Affordable Care Act and the corresponding Federal Regulation at 45 CFR Part 92 and The Americans with Disabilities Act (ADA), providers’ telemedicine or telehealth services shall accommodate the needs of individuals who have difficulty communicating due to a medical condition, who need accommodation due to a disability, advanced age or who have Limited English Proficiency (LEP) including providing access to auxiliary aids and services as described in 45 CFR Part 92;
• National Culturally and Linguistically Appropriate Services (CLAS) Standards at https://thinkculturalhealth.hhs.gov/clas/standards; and
• As applicable to the client or member, Tribal based practice standards: https://www.oregon.gov/OHA/HSD/AMH/Pages/EBP.aspx;

SOURCE:  OR OAR 140-120-0000, Medical Assistance Program: Acronyms and Definitions, (Accessed Jul. 2025).

“Face to Face” means a personal interaction where both words can be heard and facial expressions can be seen in person or through telehealth services where there is a live streaming audio and video, if medically appropriate.

SOURCE: OAR 410-172-0600 Health Systems Division: Medical Assistance Programs, Medicaid Payment for Behavioral Health Services.  (Accessed Jul. 2025).

Medical Assistance Benefits: Out of State Services

The division may not provide any payments for items or services to any financial institution or entity located outside of the United States pursuant to 1902(a)(80) of the Social Security Act.

This provision also prohibits payments to telemedicine providers and pharmacies located outside of the United States.

SOURCE: OR OAR 410-120-1180 Health Systems Division: Medical Assistance Programs Chapter 10. (Accessed Jul. 2025).

Health Professional Student Clinical Training 

“Patient” means an individual who is seeking care, guidance or treatment options at a clinical or other service location, or from a health professional or health-related professional as defined in these rules, via telehealth.

SOURCE: 409-030-0110, Oregon Health Authority, Health Systems Division: Health Professional Student Clinical Training (Accessed Jul. 2025).

Last updated 07/30/2025

Out of State Providers

A provider located in a state other than Oregon whose services are rendered in that state shall be licensed and otherwise certified by the proper agencies in the state of residence as qualified to render the services. Certain cities within 75 miles of the Oregon border may be closer for Oregon residents than major cities in Oregon, and therefore, these areas are considered contiguous areas, and providers are treated as providing in-state services.

Reimbursement and services outside the territorial limits of the United states:

• For purposes of this provision, the United States includes the District of Columbia, Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa;
• The division may not provide any payments for items or services to any financial institution or entity located outside of the United States pursuant to 1902(a)(80) of the Social Security Act.

This provision also prohibits payments to telemedicine providers and pharmacies located outside of the United States.

SOURCE: OAR 410-120-1180, (Accessed Jul. 2025).

In the event of a declared emergency or changes in federal requirements, the Authority may adopt flexibilities to remove administrative barriers and support telehealth delivered services:

• The Authority must follow guidance from the US Department of Health and Human Services (HHS) Office for Civil Rights (OCR), which may allow enforcement discretion related to privacy or security requirements.
• The Authority may expand network capacity through remote care and telehealth services provided across state lines.
• The Authority may exercise flexibilities in network adequacy requirements as described in OAR 410-141-3515.

SOURCE: OAR 410-120-1990 Health Systems Division: Medical Assistance Programs, Telehealth. (Accessed Jul. 2025).

Last updated 07/30/2025

Overview

OR Health Authority covers telehealth and telemedicine services. The definitions of which encompass video conferencing, store-and-forward imaging, streaming media including services with information transmitted via landlines, and wireless communications, including the Internet and telephone networks. Services must be culturally and linguistically appropriate.

Last updated 07/30/2025

Remote Patient Monitoring

POLICY

To encourage the efficient use of resources and to promote cost-effective procedures in accordance with ORS 413.011 (1)(L), the Oregon Health Authority shall reimburse the cost of health services delivered using telemedicine, including but not limited to:

• Health services transmitted via landlines, wireless communications, the Internet and telephone networks;
• Synchronous or asynchronous transmissions using audio only, video only, audio and video and transmission of data from remote monitoring devices; and
• Communications between providers or between one or more providers and one or more patients, family members, caregivers or guardians.

The authority shall pay the same reimbursement for a health service regardless of whether the service is provided in person or using any permissible telemedicine application or technology.

SOURCE: OR Statute 414.723. (Accessed Jul. 2025).

Teledentistry can take multiple forms, both synchronous and asynchronous, including but not limited to: …

• Remote member monitoring, where personal health and dental information is collected by dental care providers in one location then transmitted electronically to a dentist in a distant site location for use in care

SOURCE: OR OAR 410-123-1265, Health Systems Division: Medical Assistance Programs, Oregon Health Plan, Teledentistry. (Accessed Jul. 2025).

“Asynchronous” means not simultaneous or concurrent in time. For the purpose of this general rule, asynchronous telecommunication technologies for telemedicine or telehealth services may include audio and video, audio without video, client or member portal and may include remote monitoring. “Asynchronous” does not include voice messages, facsimile, electronic mail or text messages.

SOURCE: OR OAR 140-120-0000, Medical Assistance Program: Acronyms and Definitions;  and 410-120-1990 [slight variations exist], (Accessed Jul. 2025).

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CONDITIONS

No Reference Found

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PROVIDER LIMITATIONS

No Reference Found

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OTHER RESTRICTIONS

No Reference Found

Last updated 07/30/2025

Store and Forward

POLICY

To encourage the efficient use of resources and to promote cost-effective procedures in accordance with ORS 413.011 (Duties of board) (1)(L), the Oregon Health Authority shall reimburse the cost of health services delivered using telemedicine, including but not limited to:

• Health services transmitted via landlines, wireless communications, the Internet and telephone networks;
• Synchronous or asynchronous transmissions using audio only, video only, audio and video and transmission of data from remote monitoring devices; and
• Communications between providers or between one or more providers and one or more patients, family members, caregivers or guardians.

The authority shall pay the same reimbursement for a health service regardless of whether the service is provided in person or using any permissible telemedicine application or technology.

SOURCE: OR Revised Statutes Sec.  414.723, (Accessed Jul. 2025).

Clinician-to-Clinician Consultations (telephonic, online or using electronic health record)

• Covered interprofessional consultations delivered online, through electronic health records or by telephone (CPT 99446-99449, 99451-99452).

Store and forward codes (HCPCS G2010, G2250) are only covered when billed concurrently with a code that includes medical decision making and communication with the patient (for example, HCPCS G2012).

SOURCE: Oregon Health Authority, Health Evidence Review Commission, Guideline Note Changes for the Jan. 1, 2025 Prioritized List of Health Services, p. AD-3. (1/1/25). (Accessed Jul. 2025).

Behavioral Health Services:

Unless expressly authorized in OAR 410-120-1200 (Exclusions), other types of telecommunications are not covered such as images transmitted via facsimile machines and electronic mail when:

• Those methods are not being used in lieu of videoconferencing, due to limited videoconferencing equipment access; or
• Those methods and specific services are not specifically allowed pursuant to the Oregon Health Evidence Review Commission’s Prioritized List of Health Services and Evidence Based Guidelines.

SOURCE: 410-172-0850 Health Systems Division: Medical Assistance Programs, Medicaid Payment for Behavioral Health Services, Telemedicine for Behavioral Health. (Accessed Jul. 2025).

Teledentistry

Teledentistry can take multiple forms, both synchronous and asynchronous, including but not limited to: …

• Store and forward, an asynchronous transmission of recorded health information such as radiographs, photographs, video, digital impressions, or photomicrographs transmitted through a secure electronic communication system to a dentist, and it is reviewed at a later point in time by a dentist. The dentist at a distant site reviews the information without the member being present in real time.

Unless authorized in OAR 410-120-1990, other types of telecommunications such as telephone calls, images transmitted via facsimile machines, and electronic mail are not covered;

As stated in ORS 679.543 and this rule, payment for dental services may not distinguish between services performed using teledentistry, real time, or store-and-forward and services performed in-person.

SOURCE: OR OAR 410-123-1265, Health Systems Division: Medical Assistance Programs, Oregon Health Plan, Teledentistry. (Accessed Jul. 2025).

 “Asynchronous” means not simultaneous or concurrent in time. For the purpose of this general rule, asynchronous telecommunication technologies for [telemedicine or] telehealth services may include audio and video, audio without video, client or member portal and may include remote monitoring. “Asynchronous” does not include voice messages, facsimile, electronic mail or text messages.

SOURCE: OR OAR 140-120-0000, Medical Assistance Program: Acronyms and Definitions; & OAR 410-120-1990 Health Systems Division: Medical Assistance Programs, Telehealth. (Accessed Jul. 2025).

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ELIGIBLE SERVICES/SPECIALTIES

HERC prioritized list indicate interprofessional consultation codes through EHRs are reimbursable.

SOURCE: Oregon Health Authority, Health Evidence Review Commission, Guideline Note Changes for the Jan. 1, 2025 Prioritized List of Health Services, p. AD-3. (1/1/25). (Accessed Jul. 2025).

Teledentistry

Teledentistry includes store and forward.  See teledentistry section cited in previous section.

As stated in ORS 679.543 and this rule, payment for dental services may not distinguish between services performed using teledentistry, real time, or store-and-forward and services performed in-person.

SOURCE: OR OAR 410-123-1265, Health Systems Division: Medical Assistance Programs, Oregon Health Plan, Teledentistry. (Accessed Jul. 2025).

Intent to Submit a State Plan Amendment:

The Authority reimbursement of patient to clinician telephonic and electronic services for established patients are based upon the maximum allowable fees are established using the CMS Resource Based Relative Value (RBRVS) methodology as published in the Federal Register annually with periodic updates, multiplied by the Oregon specific conversion factor. Oregon conversion factors as listed on Attachment 4.19-B, page 1 of this state plan.

Except as otherwise noted in the state plan, state developed fee schedule rates are the same for both governmental and private providers. The agency’s fee schedule rate was set as of 10/1/24 and is effective for services provided on or after that date. State-wide fee schedules are published on the agency’s web at https://www.oregon.gov/oha/HSD/OHP/Pages/Fee-Schedule.aspx

SOURCE:  Oregon Health Authority, Public Notice, July 31, 2024, (Accessed Jul. 2025).

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GEOGRAPHIC LIMITS

No Reference Found

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TRANSMISSION FEE

The originating site code Q3014 is covered only when the patient is present in an appropriate health care setting and receiving services from a provider in another location.

SOURCE: Oregon Health Authority, Health Evidence Review Commission, Guideline Note Changes for the Jan. 1, 2025 Prioritized List of Health Services, p. AD-3. (11/19/24). (Accessed Jul. 2025).