Health First Colorado (Colorado's Medicaid Program) News and Updates (B2600533 - 01/2026)
Effective January 1, 2026, the HCPCS codes J1442, Q5125, J2506, Q5111, Q5127, J9312, Q5101, Q5108, Q5122 and Q5130 are added to the physician-administered drug (PAD) list that requires prior authorization (PA). Effective January 1, 2026, outpatient providers can bill transitions of care codes 99495 and 99496 in place of E/M codes 99214 and 99215 for follow-up visits within 14 days of discharge from inpatient or observation-level care. Claims billed with 2026 HCPCS procedure codes may suspend for EOB 0000 beginning January 1, 2026, and all codes must be reviewed for medical necessity, prior authorization coverage standards and rates before they are reimbursable.