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Health First Colorado (Colorado's Medicaid Program) News and Updates (B2100468 - 09/2021)
Effective date
Not stated in the notice
Identified
Jun 20, 2026
Summary
Effective May 18, 2021, Health First Colorado aligned colorectal cancer screening coverage with the USPSTF A and B recommendations, which expanded the recommended age to 45 to 75 years for adults at average risk. Fee-for-service prosthetic, orthotic and supplies rates were rebalanced to 80 to 100 percent of the Medicare benchmark effective July 1, 2021, and billing for the contraceptive pill under HCPCS S4993 was revised effective July 1, 2021. Physician-administered drugs on the listed set will require prior authorization no earlier than November 1, 2021.
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What to do
Action · 29 steps
01Already effective May 18, 2021: Apply the USPSTF colorectal cancer screening recommendation to adults 45 years and older who have no signs or symptoms of colorectal cancer and are at average risk.
02Average risk means no prior diagnosis of colorectal cancer, adenomatous polyps, or inflammatory bowel disease, and no personal diagnosis or family history of known genetic disorders that predispose to high lifetime risk, such as Lynch syndrome or familial adenomatous polyposis.
03Several screening tests are available, and providers and members consider the factors that make one test most appropriate.
04Already effective July 1, 2021: Bill prosthetic, orthotic and supplies codes at the rates on the Health First Colorado Fee Schedule.
05All prosthetic, orthotic and supplies rates also received the 2.5 percent across-the-board increase effective July 1, 2021, whether or not they were rebalanced.
06Already effective July 1, 2021: For the contraceptive pill, bill S4993 with the FP modifier when the intent is to prevent or delay pregnancy, and enter the total number of oral contraceptive packets as the units on the claim line.
07For emergency contraceptive pills, bill S4993 with modifiers FP and U1.
08When the intent is a medical service other than pregnancy prevention, bill S4993 without the FP modifier.
09Include the NDC when available.
10Already effective August 1, 2021: For Home Modification billing, submit these items to DOLA/DOH before the second Home Modification unit is released for billing: signed lien waivers for all labor and materials, including subcontractors; required permits; a one-year written warranty on materials and labor; and documentation in the member's file that the modification was completed satisfactorily.
11Operational Memo 21-053 describes the procedure.
12HCBS waiver providers bill place of service 2 when using telehealth.
13The HCBS telehealth billing change that was indicated for July 2021 is delayed until further notice, and providers continue to follow Operational Memos 20-046 and 20-090.
14For monoclonal antibody COVID-19 treatments, bill only the administration codes when doses are provided without charge from the federal government.
15If a monoclonal antibody drug code is billed, the line may pay at zero or be denied.
16For Health First Colorado members attributed to Denver Health Medicaid Choice or Rocky Mountain Health Plan PRIME, bill the administration codes and applicable drug codes to the managed care organization.
17Add-A-Baby: submit emergent requests only on the Health First Colorado Add-A-Baby Emergent Request Form, and only for newborns who need intensive care, such as border, Synagis, or NICU cases.
18Before submitting, verify with the parents that they have not already added the newborn through the county, PEAK, or the Health First Colorado App, and do not submit another request if one was already submitted.
19Do not fax the outdated paper form, and do not use this form to get a member ID.
20For non-emergent newborns, work with the parent's county Department of Human Services or Medical Assistance site.
21To verify a member ID, search the Provider Web Portal with two of the following: SSN, birth date, or member name.
22Never submit a made-up or dummy member ID.
23Pediatric Personal Care providers complete the PCAT training and then notify Christina Winship for a certificate of completion.
24Pharmacies: enter DAW 8 at point of sale when a marketplace shortage of a generic exists, and use DAW 1 or 9 for brand products on the Brand Favored Product List.
25Pharmacies must return the attestation letter by October 31, or the $9.31 dispensing fee applies.
26Prescribers must query the Colorado PDMP before prescribing controlled substances to Medicaid members, effective October 1, 2021, unless an exception applies.
27Anticipated effective October 1, 2021: a $125 per diem for facilities enrolled as Qualified Residential Treatment Programs, billed with H0019, with enrollment and billing details to follow.
28Physician-administered drugs: no earlier than November 1, 2021, make sure an approved prior authorization is on file before administering the listed PADs to Health First Colorado members; procedure criteria will be in Appendix Y.
29Check current applicability of all dates before acting.
Codes mentioned
S4993H0019Q0239M0239Q0243Q0244M0243M0244Q0245M0245M0246Q0247M0247M0248M0249M0250J0897J1459J1556J1557J1561J1566J1568J1569J1572J1599J0517J1300J1745J2182J2357J2786J3380J2323J2350J0585J0586J0587J0588
Original notice
Health First Colorado (Colorado's Medicaid Program) News and Updates (B2100468 - 09/2021)
hcpf.colorado.gov · Always check the source before changing claims.
Related changes
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Related policy hubs
Colorado Medicaid policiesCO policy changesFamily MedicineInternal MedicineGastroenterologyOB-GYNOrthopedicsPediatricsInfectious DiseasePharmacyRheumatologyNeurologyAllergy & ImmunologyPulmonologyPsychiatryCode S4993Code H0019Code Q0239Code M0239Code Q0243Code Q0244Code M0243Code M0244Code Q0245Code M0245Code M0246Code Q0247Code M0247Code M0248Code M0249Code M0250Code J0897Code J1459Code J1556Code J1557Code J1561Code J1566Code J1568Code J1569Code J1572Code J1599Code J0517Code J1300Code J1745Code J2182Code J2357Code J2786Code J3380Code J2323Code J2350Code J0585Code J0586Code J0587Code J0588