Oregon Health Authority: Tools for OHP Health Plans (coordinated care organization announcements) · July 31, 2026 · Primary source
Reimbursement for nitrous oxide during in-office medical procedures effective Aug. 1, 2026
Summary
The Oregon Health Authority (OHA) issued a memorandum effective August 1, 2026, expanding Oregon Health Plan (OHP) coverage of nitrous oxide to include use during in-office medical procedures under Ancillary Guideline A7 of the Prioritized List of Health Services. The fee-for-service reimbursement rate is set at $44.08. Providers must bill using CPT code 01999 with modifier QS, and CCOs must configure their claims processing systems to reimburse accordingly.
What this may mean
OHP providers billing for nitrous oxide in in-office settings must use CPT 01999 with the QS modifier beginning August 1, 2026, or claims will not be reimbursed at the $44.08 rate. CCOs are required to update their claims processing systems to recognize this coverage expansion for in-office procedure settings.
Informational only. Not legal, medical, financial, or other professional advice. Always consult a qualified professional familiar with your specific facts before relying on any item.
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