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Health First Colorado (Colorado's Medicaid Program) News and Updates (B2400510 - 07/2024)
Effective date
Not stated in the notice
Identified
Jun 20, 2026
Summary
Fee-for-service rates increase 2.0% for dates of service beginning July 1, 2024, with targeted rate rebalances for abortion, ambulatory surgical centers, anesthesia, dental, fee-for-service behavioral health, maternity and surgery. The dental fee schedule is updated for many preventive, endodontic, periodontic, diagnostic and crown codes, and DME manual pricing changes to acquisition cost plus 21.75% or MSRP less 13.34% for dates of service July 1, 2024 and later. Topical compounded pharmacy claims above $200.00 are subject to prior authorization criteria effective July 1, 2024, and claims for independent laboratory and radiology services begin denying effective August 1, 2024 when the OPR provider is missing or not enrolled.
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What to do
Action · 14 steps
01Already effective July 1, 2024: billing team bills fee-for-service claims at the approved 2.0% increase and the targeted rates on the Provider Rates and Fee Schedule page, and bills the usual and customary charge, since claims paid at a lower rate cannot be adjusted for the higher rate and the lower-of logic is always used.
02Billing team updates dental claims to the July 1, 2024 fee table, since codes with a targeted increase do not also receive the 2% increase.
03Billing team bills DME paid by invoice at actual acquisition cost plus 21.75%, and DME paid by Manufactured Suggested Retail Price at MSRP less 13.34%.
04Billing team confirms prior authorization for topical compounded prescriptions over $200.00 using the criteria under Topical Compound Claims in Appendix P on the Pharmacy Resources page.
05Already effective July 1, 2024 for physician-administered drugs: the servicing provider must be the billing provider when a PAD PAR is entered in Atrezzo, the PAR must be submitted to Acentra and approved before the PAD is administered, and PAD claims for the outpatient policy are billed on the CMS 1500.
06Hospital specialty drugs are billed on UB-04 claims, and member-specific PARs are submitted to the Department before administration.
07Q0224 and M0224 for pemivibart are reimbursable through September 30, 2024 or the end of the EUA, whichever comes first.
08Already effective July 1, 2024 for HCBS direct care workers: workers must be paid at least $17.00 per hour outside Denver or $18.29 within Denver, and per diem rates increase by the same percentage; the 2024 Wage Attestation Form and Provider Attestation Smartsheet form are due Previously due August 30, 2024 (date passed; verify current applicability), and claim payment suspensions may start as early as September 9, 2024.
09Already effective July 1, 2024 for SHS providers: physical therapy, occupational therapy, and speech, language and hearing claims must contain the valid NPI of the OPR provider.
10Billing team places the OPR provider NPI in CMS 1500 Field 17b; claims will begin denying effective August 1, 2024 for independent laboratory and radiology services if the OPR provider is missing or not enrolled.
11Billing team bills only one Health First Colorado member ID when transporting more than one member in the same vehicle to the same location, since multiple claims for the same vehicle's trip mileage are not reimbursed.
12NEMT providers must be credentialed Previously due August 14, 2024 (date passed; verify current applicability) and revalidate enrollment Previously due September 30, 2024 (date passed; verify current applicability); these past deadlines should be checked for current applicability.
13Already effective July 1, 2024 for OTC children's acetaminophen: coverage applies without prior authorization for children under 12, and the criteria note that use in patients younger than 42 days is not recommended.
14OTC rapid COVID-19 tests are not covered, and claims are reimbursable for dates of service through September 30, 2024.
Codes mentioned
D0120D0140D0150D1110D1120D1206D1351D1352D1354D2740D2750D2751D2752D2753D2790D2791D2792D2794D2930D3310D3320D3330D3346D3347D3348D4341D4342D4910Q0224M0224
Original notice
Health First Colorado (Colorado's Medicaid Program) News and Updates (B2400510 - 07/2024)
hcpf.colorado.gov · Always check the source before changing claims.
Related changes
See all Colorado Medicaid changes →Special Provider Bulletin - Rate Reductions (B2500528 - 09/2025)HighEffective Oct 1, 2025 · ReimbursementHealth First Colorado (Colorado's Medicaid Program) News and Updates (B2500530 - 10/2025)HighEffective Oct 1, 2025 · Provider BulletinHealth First Colorado (Colorado's Medicaid Program) News and Updates (B2000450 - 07/2020)MediumNo effective date · Provider BulletinHealth First Colorado (Colorado's Medicaid Program) News and Updates (B2200479 - 06/2022)MediumEffective Jul 1, 2022 · Provider BulletinBrowse every Colorado Medicaid change in the policy list
Related policy hubs
Colorado Medicaid policiesCO policy changesDentistryPharmacyPathologyRadiologyPhysical TherapyOccupational TherapySpeech TherapyAnesthesiologyGeneral SurgeryOphthalmologyGeneral PracticePediatricsCode D0120Code D0140Code D0150Code D1110Code D1120Code D1206Code D1351Code D1352Code D1354Code D2740Code D2750Code D2751Code D2752Code D2753Code D2790Code D2791Code D2792Code D2794Code D2930Code D3310Code D3320Code D3330Code D3346Code D3347Code D3348Code D4341Code D4342Code D4910Code Q0224Code M0224