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Colorado MedicaidMedicaid · Reimbursement · Provider Bulletin · COMedium impact

Health First Colorado (Colorado's Medicaid Program) News and Updates (B2100461 - 04/2021)

Effective date
May 1, 2021
Identified
Jun 20, 2026

Summary

Suppliers must enter from and to dates of service on claims for diabetic testing supplies, continuous passive motion devices, parenteral and enteral nutrition and administration kits, and external infusion pump supplies, which may have a date span of up to 30 calendar days. When doses of bamlanivimab or casirivimab and imdevimab, or bamlanivimab and etesevimab, are provided without charge from the federal government, providers should bill only the administration procedure codes, and FQHCs can be reimbursed at fee schedule rates for COVID-19 vaccine administration and monoclonal antibody treatments. All COVID-19 vaccine claims are reimbursed at $41.18 effective March 15, 2021, and the monoclonal antibody administration codes M0239, M0243 and M0245 carry a fee-for-service rate of $309.60 each.

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What to do

Action · 12 steps
01Billing team: Enter the from and to dates of service on claims for diabetic testing supplies, continuous passive motion devices, parenteral and enteral nutrition, parenteral and enteral administration kits and external infusion pump supplies.
02The from date is when the items were provided to the member, and the to date is the last date the supplies are expected to be used.
03For example, a 30-day supply of diabetic testing strips provided on 01/01/2021 would show a to date of 01/30/2021.
04Billing team: For monoclonal antibody doses provided without charge from the federal government, submit claims only for the administration procedure codes M0239, M0243 and M0245, and do not include the monoclonal antibody product codes Q0239, Q0243 and Q0245.
05If codes are billed for the monoclonal antibodies, the line(s) may pay at zero or be denied.
06Billing team: For FQHC reimbursement of COVID-19 vaccine administration and monoclonal antibody treatments at fee schedule rates, submit a professional claim (CMS1500/837p).
07If the service is part of a regular billable visit, submit two separate claims: one institutional claim for the encounter rate reimbursement and one professional claim for the fee schedule reimbursement.
08Billing team: Bill COVID-19 vaccine administration codes 0001A, 0002A, 0011A, 0012A and 0031A.
09The vaccines are provided at no cost, so only the administration fee is reimbursed.
10Pharmacy: Trulicity pen injector is preferred effective April 1, 2021, and preferred GLP-1 analogues require a 3-month trial of metformin therapy, or documented contraindication to it, before approval.
11Providers: Submit PARs to Kepro beginning May 1, 2021 for select outpatient services, including audiology, durable medical equipment, medical procedures, diagnostic imaging, molecular testing, pediatric behavioral therapy and outpatient speech, occupational and physical therapy, for codes that require a PAR under the Health First Colorado Fee Schedule.
12Check current applicability of these dated items before acting on them.

Codes mentioned

Q0239M0239Q0243M0243Q0245M0245

Original notice

Health First Colorado (Colorado's Medicaid Program) News and Updates (B2100461 - 04/2021)
hcpf.colorado.gov · Always check the source before changing claims.
View original ↗

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Related policy hubs

Colorado Medicaid policiesCO policy changesCode Q0239Code M0239Code Q0243Code M0243Code Q0245Code M0245

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