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Health First Colorado (Colorado's Medicaid Program) News and Updates (B2000450 - 07/2020)
Effective date
Not stated in the notice
Identified
Jun 20, 2026
Summary
Effective July 1, 2020, Health First Colorado applied a 1.0 percent across the board rate decrease to many service categories, with most rates subject to CMS approval before implementation, and HCBS waiver services reduced without CMS approval. The bulletin also said CPT codes 80320 through 80377 are anticipated to stop being billable for dates of service on or after September 1, 2020, to be replaced by HCPCS codes G0480 through G0483, and IntelliRide took over the NEMT benefit statewide effective July 1, 2020.
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What to do
Action · 20 steps
01Already effective July 1, 2020 (rate decrease): Check the updated fee schedules on the Provider Rates and Fee Schedule web page, and check every fee schedule that applies to your billing, because not all codes are listed on the Health First Colorado Fee Schedule.
02Rates in the Colorado interChange update once CMS approves them.
03Bill your usual and customary charges, because the 'lower of' pricing logic means claims already billed and paid at a lower rate cannot be adjusted for a higher rate.
04Already effective July 1, 2020 (HCBS waivers): Claims with dates of service on or after July 1, 2020 are reimbursed at the decreased rate for the listed HCBS waivers.
05Verify new rates for set-rate services in the Provider Web Portal or with the member's case manager after July 1, 2020.
06Services with negotiated or manually priced rates are not reduced, so continue to bill the approved rate on the prior authorization.
07For Alternative Care Facilities (T2031) and Supportive Living Program (T2033) services, existing PETIs and PAR lines were end-dated June 30, 2020 and recreated at the decreased rate starting July 1, 2020.
08Review the HCBS Fee Schedule effective July 1, 2020.
09CDASS rates decrease effective September 1, 2020.
10Already effective July 1, 2020 (home health and private duty nursing): PAR requirements are suspended for Pediatric Long-Term Home Health and Private Duty Nursing for dates of service beginning July 1, 2020, until approximately September 30, 2020 if not later.
11Providers should continue to provide and bill only medically necessary and ordered services, because failure to comply may result in compliance monitoring and recovery of identified overpayments.
12Already effective July 1, 2020 (NEMT): Trips billed for July 1, 2020 or later must be billed through IntelliRide instead of the fiscal agent or county administrators, and trips completed Previously due July 1, 2020 (date passed; verify current applicability) use current processes.
13Providers outside the current IntelliRide service area, or in it and looking to expand, can email us.join_our_network@transdev.com to join the network.
14Telemedicine: Bill telemedicine only when the member initiated it, it meets the same standard of care as in-person care, it is medically necessary or necessary to support the member in the community, it is within the rendering provider's scope of practice, and it meets the same documentation requirements.
15Unsolicited phone calls to members by a provider are not reimbursable.
16Outpatient hospitals: Expect demand letters from the Department for finalized cost reports covering periods before EAPG implementation, as outpatient cost settlements resume in mid-July.
17Prior authorization vendor: Call eQHealth Solutions first for PAR status or help with eQSuite, or email co.pr@eqhs.com with the Review ID, PAR number, Medicaid ID, ticket number and call number.
18Nasal atomizer (A4210): A pharmacy may bill HCPCS A4210 as a professional claim, up to 15 per year, without prior authorization, using the appropriate diagnosis code if one is required.
19Early Intervention therapy: Attach the approved IFSP to the PAR, and bill units up to but not exceeding the units approved on the PAR.
20Watch for a notice that CPT codes 80320 through 80377 will no longer be billable for dates of service on or after September 1, 2020 and will be replaced by G0480 through G0483.
Codes mentioned
A42108032080377G0480G0483T2031T2033
Original notice
Health First Colorado (Colorado's Medicaid Program) News and Updates (B2000450 - 07/2020)
hcpf.colorado.gov · Always check the source before changing claims.
Related changes
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