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Health First Colorado (Colorado's Medicaid Program) News and Updates (B2000448 - 05/2020)
Effective date
Not stated in the notice
Identified
Jun 20, 2026
Summary
Effective for dates of service beginning May 1, 2020, HCPCS V2785 was placed in ASC payment group 11, priced at $3,418.65, and that payment includes acquisition of corneal tissue and the facility payment for the associated surgical procedure. Effective March 1, 2020, COVID-19 medication co-pays are waived when ICD-10 code U07.1 is entered on the claim transmittal, and prior authorization is required for all immune globulin products listed on the Preferred Drug List effective April 1, 2020.
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What to do
Action · 14 steps
01Already effective May 1, 2020 (ASC grouper): Bill HCPCS V2785 in ASC payment group 11 for dates of service beginning May 1, 2020, and refer to the Ambulatory Surgery Centers (ASC) Billing Manual for the ASC payment methodology.
02Commercial insurance (TPL): Bill commercial insurance first, because Health First Colorado is the payer of last resort, and encourage members to report all available coverage.
03Do not bill members for the difference between TPL payments and billed charges when Health First Colorado makes no additional payment, and do not bill members for co-pay or deductible assessed by the TPL coverage.
04A printable poster in Spanish and English is available from Eujenia.Renfroe@state.co.us.
05Ordering, prescribing and referring (OPR) providers: Every NPI listed on a claim must be enrolled with Health First Colorado, including providers who do not bill claims directly.
06Already effective April 1, 2020 (immune globulins): Bill immune globulin covered under the pharmacy benefit as a pharmacy claim, and bill all other claims through the medical benefit.
07If immune globulin is administered by a healthcare provider in a long-term care facility or in a member's home, bill it as a pharmacy claim.
08Members with an existing approval may continue until the authorization end date, and members newly starting an immune globulin are subject to the Preferred Drug List criteria.
09Already effective March 1, 2020 (COVID-19 medications): Enter ICD-10 code U07.1 on the claim transmittal for the co-pay waiver, and pharmacists should ensure the diagnosis is documented on the electronic or hardcopy prescription.
10Already effective April 6, 2020: An existing 12-month prior authorization may be deferred once and extended one time for 90 days if requested by an enrolled prescriber, a pharmacist within an enrolled pharmacy, or their designee, through the Magellan Rx Management Pharmacy Call Center at 1-800-424-5725.
11Already effective March 25, 2020: Prescription cough and cold products do not require a prior authorization for Health First Colorado members.
12Already effective March 24, 2020: Chloroquine and hydroxychloroquine require a prior authorization.
13Pharmacies may override early refills at the point of sale after 50% of the medication day supply has lapsed for COVID-19 related reasons, using DUE response codes with reason for service code 'ER'; this override is not available for mail order pharmacies.
14Signature requirements for member counseling and proof of delivery are temporarily waived, and pharmacies must keep records indicating when counseling was not or could not be provided.
Codes mentioned
V2785U07.1
Original notice
Health First Colorado (Colorado's Medicaid Program) News and Updates (B2000448 - 05/2020)
hcpf.colorado.gov · Always check the source before changing claims.
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