New Oregon Medical Service/Billing Rules in Effect this Week
In February, I sent out an update about some possible changes to the medical billing, treatment, and MCO rules.
The WCD is moving forward with implementing some of those changes, which take effect this week (April 1, 2026).
You can find the text here.
These changes include:
- Changes to medical billing rates;
- Sets a maximum rate for platelet rich plasma (PRP) injections;
- Requires insurer to pay for a WRME addendum report when the report is issued in response to an IME addendum report;
- Clarifies when an insurer denies a claim, an interpreter may only bill a worker if the interpreter is chosen by the worker;
- Requires insurer to respond to medical provider or interpreter questions during regular Oregon business hours (8:00 AM to 5:00 PM Pacific Time);
- Clarifies medically stationary notices must be sent out within 7 days of knowledge the worker is stationary and must go to all actively treating ancillary providers (in addition to the attending physician);
- Allows a worker to continue to treat with a current medical service provider for up to 30 days after the mailing of an MCO enrollment notice.
Please note the proposed rules in February included new requirements about responding to pre-authorization requests for physical therapy, occupational therapy, speech/language therapy, referrals, or diagnostics. The WCD is not currently moving forward with these changes, but we may still see some variations in the pre-authorization process in the near future.
If you have any questions about these changes, please do not hesitate to reach out to me at or (503) 595-2130.
Posted by Kevin Anderson.
