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Health First Colorado (Colorado's Medicaid Program) News and Updates (B2100466 - 08/2021)
Effective date
Not stated in the notice
Identified
Jun 20, 2026
Summary
Relying solely on billing statements, member notification, or collection agencies is not effective, so providers must take appropriate and reasonable action to identify Health First Colorado eligibility within 365 days. Fee-for-service behavioral health codes were rebalanced to 80 to 100 percent of the Medicare benchmark effective April 1, 2021, and Medicaid prescribers of controlled substances must query the Colorado Prescription Drug Monitoring Program before prescribing to Medicaid members effective October 1, 2021, except in the listed situations. Physician-administered drugs on the listed set will require prior authorization no earlier than October 1, 2021.
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What to do
Action · 15 steps
01Already effective April 1, 2021: Check the fee-for-service behavioral health codes in the Health First Colorado Fee Schedule.
02Rates below 80 percent of Medicare were raised to 80 percent, and rates above 100 percent were reduced to 100 percent.
03Already effective July 1, 2021: Peristeen supplies can be requested and billed with HCPCS E1399, where one unit equals three months of supplies.
04Claims are manually priced under the DMEPOS billing manual, and this coding is temporary until further notice from the Department.
05Already effective July 1, 2021: The T1019 rate increased to $4.99 per 15-minute unit, and T1019 care within Denver County is reimbursed at $5.89 per 15-minute unit.
06Claims for T1019 provided since January 1, 2021 were reprocessed to the higher rate, and providers who submitted claims at the prior rate must resubmit them at the new rate to receive the increase.
07Already effective August 1, 2021: Bill definitive drug testing with HCPCS G0480 through G0483, because CPT codes 80320 through 80377 are discontinued.
08Already effective October 1, 2021: Providers permitted to prescribe controlled substances must query the Colorado PDMP before prescribing controlled substances to Medicaid members, unless the member falls under one of the listed situations.
09Prescribers should keep the Real-Time Benefit Check capabilities enabled in their EHR so they do not miss the Medicaid value-based payments.
10Change of ownership with a new EIN: the new owner submits a new enrollment application, sets the Change of Ownership field to Yes, and completes the Previous Ownership section with the selling provider's information.
11The selling provider must submit a voluntary disenrollment request through the Provider Web Portal before the application can be processed.
12New owners cannot submit claims before the enrollment application is approved, and cannot use the selling provider's EIN or NPI/Health First Colorado ID.
13Voluntary disenrollment requests must have a requested date no less than 30 days and no more than 90 days from the current date, except change of ownership disenrollments, which can use the current date, a future date, or a retroactive date within the current calendar year.
14Legal name changes are submitted with the Legal Name Change Form through the Provider Web Portal, with the required documentation.
15Check current applicability of all dates before acting.
Codes mentioned
907919079290832908339083490836908379083890839908409084690847908499085396105961109612596127H0001H0004H0005H0006S9445E1399G0480G0483T10198032080377J0897J1459J1556J1557J1561J1566J1568J1569J1572J1599J0517J1300J1745J2182J2357J2786J3380J2323J2350J0585J0586J0587J0588
Original notice
Health First Colorado (Colorado's Medicaid Program) News and Updates (B2100466 - 08/2021)
hcpf.colorado.gov · Always check the source before changing claims.
Related changes
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