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Health First Colorado (Colorado's Medicaid Program) News and Updates (B2100471 - 12/2021)
Effective date
Not stated in the notice
Identified
Jun 20, 2026
Summary
The December 2021 Health First Colorado provider bulletin (B2100471) lists several changes, the largest being billing guidance for COVID-19 monoclonal antibody and tocilizumab administration codes. When the federal government provides the doses at no charge, the bulletin says providers should bill only the administration codes, and the antibody-specific codes may pay at zero or be denied if billed. It also adds electronic visit verification claim denials starting February 1, 2022, a home dialysis benefit for emergency Medicaid ESRD recipients from January 1, 2022, and a requirement that every NPI on a claim be enrolled with Health First Colorado.
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What to do
Action · 13 steps
01Already effective February 1, 2022: All claims requiring electronic visit verification (EVV) will encounter a pre-payment review, and claims without the necessary EVV records will deny with EOB 3054.
02Providers should check EVV records before billing.
03Already effective January 1, 2022: Home dialysis is a covered benefit for recipients of Emergency Medicaid Services with ESRD.
04Providers must certify the emergency medical condition and indicate it on the claim: use field 24C (EMG) on the CMS-1500 or 835P, and Admission Type 1 (Emergency) or 5 (Trauma) on the UB-04 or 837I.
05For services performed at home, use Condition Code 74.
06COVID-19 monoclonal antibodies: Bill only the administration codes, and do not include the antibody-specific codes when the federal government provides the doses free of charge.
07Members attributed to Denver Health Medicaid Choice or Rocky Mountain Health Plan PRIME should have infusion administration codes billed to the managed care organization.
08Already effective December 1, 2021: Records dated on or after December 1, 2015 must be retained for seven years under Section 8.130.
09Billing team: Confirm that every NPI listed on a claim is enrolled with Health First Colorado by calling the Provider Services Call Center before billing.
10Electrolysis (CPT 17380) is a covered benefit for members meeting the Transgender Services Billing Manual requirements when used to treat a surgical site, and providers must be enrolled to be paid.
11Already effective November 2, 2021: Prior authorization requests for the listed diagnostic imaging codes were temporarily suspended.
12Physician-administered drugs: once the prior authorization requirement is implemented, ensure an approved prior authorization is on file before administering the listed drugs.
13Check current applicability of all of these dates before acting on them.
Codes mentioned
17380Q0239M0239Q0240M0240M0241Q0243Q0244M0243M0244Q0245M0245M0246Q0247M0247M0248Q0249M0249M02507415074160741707417474175741767417774178721917219372194J0897J1459J1556J1557J1561J1566J1568J1569J1572J1599J0517J1300J1745J2182J2357J2786J3380J2323J2350J0585J0586J0587J0588
Original notice
Health First Colorado (Colorado's Medicaid Program) News and Updates (B2100471 - 12/2021)
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 (B2100468 - 09/2021)MediumNo effective date · Provider BulletinHealth First Colorado (Colorado's Medicaid Program) News and Updates (B2100463 - 05/2021)MediumNo effective date · Provider BulletinHealth First Colorado (Colorado's Medicaid Program) News and Updates (B2100464 - 06/2021)MediumNo effective date · Provider BulletinHealth First Colorado (Colorado's Medicaid Program) News and Updates (B2100466 - 08/2021)MediumNo effective date · Provider BulletinBrowse every Colorado Medicaid change in the policy list
Related policy hubs
Colorado Medicaid policiesCO policy changesCode 17380Code Q0239Code M0239Code Q0240Code M0240Code M0241Code Q0243Code Q0244Code M0243Code M0244Code Q0245Code M0245Code M0246Code Q0247Code M0247Code M0248Code Q0249Code M0249Code M0250Code 74150Code 74160Code 74170Code 74174Code 74175Code 74176Code 74177Code 74178Code 72191Code 72193Code 72194Code J0897Code J1459Code J1556Code J1557Code J1561Code J1566Code J1568Code J1569Code J1572Code J1599Code J0517Code J1300Code J1745Code J2182Code J2357Code J2786Code J3380Code J2323Code J2350Code J0585Code J0586Code J0587Code J0588