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Colorado MedicaidMedicaid · Billing Codes · Provider Bulletin · CO · Pediatrics, Physical Therapy, Occupational Therapy +6 moreMedium impact

Health First Colorado (Colorado's Medicaid Program) News and Updates (B2200476 - 03/2022)

Effective date
Jul 1, 2022
Identified
Jun 20, 2026

Summary

Effective July 1, 2022, claims for outpatient physical, occupational and speech therapy, laboratory and radiology, audiology, home health, private duty nursing and pediatric personal care must contain the NPI of the ordering provider, and that NPI must be actively enrolled with Health First Colorado. Co-treatment between pediatric behavioral therapists, physical therapists, occupational therapists and speech therapists is covered only when valid clinical rationale exists, each provider has an approved Plan of Care or IFSP that includes co-treatment, an approved prior authorization includes that documentation, and each provider bills only the time they directly treat the member. Effective July 1, 2022, gender identity diagnoses F64.0 through F64.9 are reimbursed only through the capitated behavioral health program for members enrolled in the Accountable Care Collaborative and assigned to a Regional Accountable Entity.

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What to do

Action · 12 steps
01Already effective July 1, 2022: Billing team enters the ordering provider NPI on claims for outpatient physical, occupational and speech therapy, laboratory and radiology, audiology, home health, private duty nursing and pediatric personal care.
02On paper professional claims use field 17.b, on electronic professional claims use loop 2420e with qualifier DK, and on institutional claims use the Attending Provider field.
03The ordering provider must be actively enrolled with Health First Colorado, and claims where these conditions are not met will be denied.
04Already effective July 1, 2022: For co-treatment, confirm each provider's Plan of Care or IFSP and the prior authorization include co-treatment, and bill each provider only for the time that provider directly treats the member.
05For example, CPT 92507 is one unit per visit and CPT 97153 is billed in 15-minute increments.
06Already effective July 1, 2022: Behavioral health providers stop billing the outpatient behavioral health fee-for-service benefit for F64.0 through F64.9 when the member is in the Accountable Care Collaborative and assigned to a Regional Accountable Entity, and contract directly with the RAE to bill those services.
07For COVID-19 vaccine counseling-only visits, bill CPT 99401 with modifier CR, once per member per day, and do not bill 99401 with the vaccine administration code on the same date of service.
08For Medicare crossover claims for G2067 through G2075, submit the secondary claim to Gainwell Technologies Fee-For-Service, not the Regional Accountable Entity.
09For DMEPOS safety items, do not submit items that are not permanently affixed, such as items attached by suction cup or tension mechanism, because they will not be approved.
10For E0241, E0242, E0243 and E0246 submitted in Atrezzo, confirm the member was educated on proper use and installation as required by CCR 2505-10 8.590.4.F.
11When doses of COVID-19 therapy are provided free from the federal government, bill the administration procedure codes, since monoclonal antibody or other therapy lines billed may pay at zero or be denied.
12Check current applicability before acting on any of these dates.

Codes mentioned

F64.0F64.1F64.2F64.8F64.99250797153994019934199350J3398G2067G2075E0241E0242E0243E0246A4436A4437J02489636596366Q0220M0220M0221Q0239M0239Q0240M0240M0241Q0243Q0244M0243M0244Q0245M0245M0246Q0247M0247M0248Q0249M0249M0250

Original notice

Health First Colorado (Colorado's Medicaid Program) News and Updates (B2200476 - 03/2022)
hcpf.colorado.gov · Always check the source before changing claims.
View original ↗

Related changes

See all Colorado Medicaid changes →
Health First Colorado (Colorado's Medicaid Program) News and Updates (B2100471 - 12/2021)MediumNo effective date · Provider BulletinHealth First Colorado (Colorado's Medicaid Program) News and Updates (B2100468 - 09/2021)MediumNo effective date · Provider BulletinHealth First Colorado (Colorado's Medicaid Program) News and Updates (B2100461 - 04/2021)MediumEffective May 1, 2021 · Provider BulletinHealth First Colorado (Colorado's Medicaid Program) News and Updates (B2200475 - 02/2022)MediumNo effective date · Provider BulletinBrowse every Colorado Medicaid change in the policy list

Related policy hubs

Colorado Medicaid policiesCO policy changesPediatricsPhysical TherapyOccupational TherapySpeech TherapyAudiologyPathologyRadiologyPharmacyGeneral PracticeCode F64.0Code F64.1Code F64.2Code F64.8Code F64.9Code 92507Code 97153Code 99401Code 99341Code 99350Code J3398Code G2067Code G2075Code E0241Code E0242Code E0243Code E0246Code A4436Code A4437Code J0248Code 96365Code 96366Code Q0220Code M0220Code M0221Code Q0239Code M0239Code Q0240Code M0240Code M0241Code Q0243Code Q0244Code M0243Code M0244Code Q0245Code M0245Code M0246Code Q0247Code M0247Code M0248Code Q0249Code M0249Code M0250

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