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Health First Colorado (Colorado's Medicaid Program) News and Updates (B2300495 - 06/2023)
Effective date
Not stated in the notice
Identified
Jun 20, 2026
Summary
Health First Colorado across-the-board provider rate increases of 3.0% apply to dates of service beginning July 1, 2023, along with targeted rate rebalances for listed service categories including cardiology, radiology, and primary care and evaluation and management. A directed payment minimum rate fee schedule applies to behavioral health codes H0036, H0037, H2015, H2016, H2021, H2022 and H2033 effective July 1, 2023. Family planning-related services for members in the Emergency Medical Services and Reproductive Health Care Program category have a $0 co-pay effective July 1, 2023, and coverage of laboratory codes 0202U, 0223U, 0224U, 0225U, 0226U, 0240U and 0241U remains after the end of the public health emergency.
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What to do
Action · 16 steps
01Already effective July 1, 2023 (rates): The approved 3.0% across-the-board increase and the targeted rate rebalances apply to dates of service beginning July 1, 2023, and the rates will be updated in the Colorado interChange for those dates of service.
02Already effective July 1, 2023 (family planning): Family planning services should continue to have an FP modifier at the detail level of the claim, and family planning-related services provided during or in follow up to a family planning visit are billed with the FP+32 modifier at the detail level.
03Pharmacy providers use field 461-EU with 6- Family Plan for family planning-related medications, and the prescriber submits a Prior Authorization Request if the medication is not on the family planning-related drug list.
04Already effective July 1, 2023 (behavioral health crisis services): Mobile Crisis Response claims may not be submitted by Behavioral Health Crisis Services MCR specialty providers until that provider type is available, and MCR services rendered before then are not eligible for Health First Colorado reimbursement.
05Already effective July 1, 2023 (behavioral health directed payments): Managed care entities are required to update provider contracts and claims systems to reflect a rate no less than the directed payment rate.
06Already effective May 1, 2023 (take-home buprenorphine): Opioid treatment providers bill the NDC and HCPCS of the take-home oral buprenorphine product with the take-home supply on a separate line, with a date span of no more than seven days and place of service home (12).
07Historical deadline November 11, 2023 (revalidation): Providers with revalidation due dates from October 1, 2020 through November 11, 2023 who had no claims activity in the last 3 years must revalidate Previously due November 11, 2023 (date passed; verify current applicability), and providers that do not complete revalidation by their revalidation due date will be subject to claims denial or disenrollment.
08Ongoing (enrollment): Providers must ensure all enrollment requirements are met, including application fees, fingerprinting and site visits that were waived during the PHE, to avoid disenrollment and claim denials.
09Ongoing (CHP+ billing): When a CHP+ member's eligibility start date occurs before enrollment with a CHP+ Managed Care Organization, claims must be billed directly to the fiscal agent, and after the member is assigned a managed care organization, claims must be billed to that MCO.
10Ongoing (clinical trials): Providers submitting a PAR for routine care during a qualified clinical study or trial must include the clinical appropriateness attestation form to ensure a determination within a two-day Turn Around Time, and failure to submit the form results in a normal PAR Turn Around Time.
11Already effective July 1, 2023 (SB 21-137): Providers sponsor the request for second medical necessity review when a Regional Accountable Entity denies or reduces SUD services and the member's appeal is denied by a Colorado Administrative Law Judge.
12Already effective after the PHE (telemedicine): Providers must obtain written consent prior to the first visit post-PHE, as described in the Telemedicine Billing Manual.
13Already effective January 14, 2023 (optometry): The listed CPT codes are available to optometrists.
14Already effective June 15, 2023 (Provider Web Portal): Claims submitted in the Provider Web Portal show a new Payer drop-down, with Title XIX Payer as its only value.
15Ongoing (NPI): Providers will soon be required to use an NPI that is not already active on a pending enrollment application or pending NPI change maintenance request, and an error message appears if the NPI is already included on an active enrollment or maintenance ATN.
16Check current applicability of the dated items before acting on them.
Codes mentioned
H0036H0037H2015H2016H2021H2022H2033J0571J0572J0573J0574J057599382993839938499392993939939410060101201110211103112001120111310119006543065435654366577866762688411144065855667616682167515678006780167805678206782567840679216793068020682006876068761
Original notice
Health First Colorado (Colorado's Medicaid Program) News and Updates (B2300495 - 06/2023)
hcpf.colorado.gov · Always check the source before changing claims.
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Related policy hubs
Colorado Medicaid policiesCO policy changesCode H0036Code H0037Code H2015Code H2016Code H2021Code H2022Code H2033Code J0571Code J0572Code J0573Code J0574Code J0575Code 99382Code 99383Code 99384Code 99392Code 99393Code 99394Code 10060Code 10120Code 11102Code 11103Code 11200Code 11201Code 11310Code 11900Code 65430Code 65435Code 65436Code 65778Code 66762Code 68841Code 11440Code 65855Code 66761Code 66821Code 67515Code 67800Code 67801Code 67805Code 67820Code 67825Code 67840Code 67921Code 67930Code 68020Code 68200Code 68760Code 68761