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Health First Colorado (Colorado's Medicaid Program) News and Updates (B2300501 - 11/2023)
Effective date
Not stated in the notice
Identified
Jun 20, 2026
Summary
Vaccine counseling visits are billed with CPT G0310 through G0315, limited to one visit per member per day, and COVID-19 counseling-only visits use modifier CR. NEMT claims billed with A0425 or S0209 are suspended for review when billed units exceed 52, and suspended claims are denied if they do not have an attachment that meets the listed requirements. Pharmacists who receive denial code 6Z/50602 are encouraged to complete a prior authorization with Magellan to receive reimbursement, effective November 15, 2023.
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What to do
Action · 15 steps
01Already effective October 30, 2023: The hospital services policy was updated to clarify when inpatient, outpatient and observation stays are appropriate based on medical necessity; refer to the IP/OP Billing Manual.
02Already effective November 15, 2023: Pharmacists receiving denial code 6Z/50602 should call Magellan to complete a prior authorization, with the prescribing pharmacist as the point of contact.
03Vaccines: bill G0310 through G0315 for vaccine counseling, once per member per day, with modifier CR for COVID-19 counseling-only visits, and do not bill the counseling code and the vaccine administration code on the same date of service when administration codes include counseling.
04Report a separate E/M visit with modifier 25 only if it is separately identifiable from vaccine counseling and immunization administration.
05Rabies vaccine rates effective September 26, 2023: 90375 at $293.67, 90376 at $274.36 and 90675 at $338.27; claims submitted at the previous lower rate must be adjusted.
06Pediatric personal care (T1019): rates were corrected for the July 1, 2023 increase; providers billing the fee schedule rate must manually adjust claims, and providers billing usual and customary charges will see claims adjustments through reprocessing.
07NEMT (A0425 or S0209 over 52 billed units): suspended claims are denied without an attachment containing the pick-up and destination addresses, date and time of the trip, member name or identifier, confirmation that the driver verified identity, confirmation by the member, escort or facility that the trip occurred, actual pick-up and drop-off times, the driver's name, the vehicle identification, and a treating provider rationale and certification for transport beyond the closest provider within 25 miles.
08Speech therapy (implementation anticipated December 2023): one date of service equals one session toward 12 sessions before a PAR is required; CPT 92507 and 92526 each have an MUE of one unit; request a PAR before the 12 sessions are exhausted if more are needed.
09School Health Services: the 120-day timely filing requirement applies from the date of service, and fee-for-service claims are still required even though they are paid at zero.
10Outpatient hospital specialty drugs: Ultomiris and Xenpozyme were added to the EAPG carveout list effective August 2, 2023 and August 10, 2023; an approved PAR must be on file before any future date of service, or the claim line will be denied.
11SBIRT: when screening and brief intervention do not meet the 15-minute threshold of 99408, bill an E/M code with modifier 25 if it is separately identifiable and documented, and H0049 can be billed in addition to the E/M when a full screening is negative.
12Provider enrollment: submit a provider maintenance update for mailing, billing and service location addresses, contact information, and owner or managing employee information; EFT changes can take up to two weeks, with paper checks mailed in the interim.
13IRS 1099 mailing address: review and update it in the Provider Web Portal before January 2024, since the address is linked to the tax ID.
14Behavioral health: the SB 23-174 policy to cover outpatient psychotherapy services for members under 21 without a covered diagnosis goes into effect July 1, 2024, and providers can review the SB 23-174 Coverage Policy web page.
15Check current applicability before acting on these dates.
Codes mentioned
G0310G0311G0312G0313G0314G03159067890679903759037690675963729940199404A0425S020999408H00499250792526T1019
Original notice
Health First Colorado (Colorado's Medicaid Program) News and Updates (B2300501 - 11/2023)
hcpf.colorado.gov · Always check the source before changing claims.
Related changes
See all Colorado Medicaid changes →Health First Colorado (Colorado's Medicaid Program) News and Updates (B2200480 - 07/2022)MediumEffective Jun 29, 2022 · Provider BulletinHealth First Colorado (Colorado's Medicaid Program) News and Updates (B2200482 - 09/2022)MediumEffective Sep 1, 2022 · Provider BulletinHealth First Colorado (Colorado's Medicaid Program) News and Updates (B2600539 - 06/2026)HighNo effective date · Provider BulletinHealth First Colorado (Colorado's Medicaid Program) News and Updates (B2000455 - 11/2020)MediumEffective Jan 1, 2021 · Provider BulletinBrowse every Colorado Medicaid change in the policy list