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Health First Colorado (Colorado's Medicaid Program) News and Updates (B2100465 - 07/2021)
Effective date
Not stated in the notice
Identified
Jun 20, 2026
Summary
Health First Colorado's 2.5 percent across-the-board provider rate increases apply to dates of service starting July 1, 2021, once CMS approves them, and claims already paid at a lower rate are not adjusted for the higher rate. Effective July 1, 2021, cholesterol supplement products are billed with HCPCS B9998 and modifier U1, and HCPCS L8687 requires prior authorization. Definitive drug testing CPT codes 80320 through 80377 remained billable through July 31, 2021, and were replaced by HCPCS G0480 through G0483 starting August 1, 2021.
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What to do
Action · 14 steps
01Already effective July 1, 2021: For CHP+ members whose eligibility start date is before MCO enrollment, bill the claim directly to Gainwell.
02Once the member is assigned a managed care organization, bill that MCO.
03Pharmacy claims for CHP+ members are submitted to Magellan.
04Make sure you have an active contract with a CHP+ MCO before billing services to CHP+ members starting July 1, 2021.
05Request prior authorization through ColoradoPAR before providing HCPCS L8687, which requires prior authorization, and before billing EPSDT wipes, which are coded exclusively as A9286 and require prior authorization.
06Code cholesterol supplement products as B9998 with the U1 modifier for new prior authorization requests and claims, and start that prior authorization process on ColoradoPAR.
07Clinic providers billing L3000 must meet the PAR requirements listed on the Provider Rates and Fee Schedule web page, and submit PARs through Kepro.
08For home dialysis claims billed with revenue code 841 or 851 and condition code 74, new claims are suspended under edit 853 and processed manually as an interim solution.
09Effective September 1, 2021, providers who bill telehealth for specific HCBS waiver services must use new modifiers; billing manuals and rate sheets will be updated, and the changes will be outlined in a forthcoming memo, so watch for that memo.
10Definitive drug testing: bill CPT 80320 through 80377 only through July 31, 2021, and from August 1, 2021 bill HCPCS G0480 through G0483 as described in the Laboratory Billing Manual.
11The 2.5 percent increases will be loaded in the Colorado interChange once CMS approval is received.
12PRTF providers: the per diem rate is targeted at $750.00 per day effective July 1, 2021.
13Rural health clinics: licensed professional counselors, licensed marriage and family therapists, and licensed addiction counselors generate billable encounters effective March 9, 2021.
14Check current applicability of all dates before acting.
Codes mentioned
L8687B9998A9286L30008032080377G0480G0483
Original notice
Health First Colorado (Colorado's Medicaid Program) News and Updates (B2100465 - 07/2021)
hcpf.colorado.gov · Always check the source before changing claims.
Related changes
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