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Health First Colorado (Colorado's Medicaid Program) News and Updates (B2600540 - 07/2026)
Act
by Jan 1, 2027
Effective date
Not stated in the notice
Identified
Jul 1, 2026
Summary
A 2% across-the-board Health First Colorado provider rate reduction applies to dates of service beginning July 1, 2026, with exemptions for managed care, pharmacy, RHCs, FQHCs, pediatric behavioral therapy, select NICU and neonatal services, select maternity services, and family planning services. Procedure codes 97535 and 97537 are no longer covered as of July 1, 2026, and CPT 77063 became a covered benefit that must be billed on the same claim as CPT 77067. Effective August 1, 2026, PT 25 and PT 16 claims will be denied when billed for certain behavioral health supportive and team-based services in fee-for-service or to the Regional Accountable Entities.
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What to do
by Jan 1, 2027 · 14 steps
01Enroll each behavioral health provider, including pre-licensed clinicians and unlicensed professionals, with an individual NPI obtained through NPPES, and list that NPI on claims submitted to the Regional Accountable Entities (RAEs).
02Already effective August 1, 2026: PT 25 and PT 16 claims for the listed behavioral health supportive and team-based codes will be denied.
03Behavioral health group practices can enroll as PT 77 Behavioral Health Group, using Option 1 (a new organizational Type II NPI, which allows the enrollment effective date to be backdated up to 10 months when applicable) or Option 2 (retain the current NPI and request disenrollment, which takes 30 days).
04Contact hcpf_bhbenefits@state.co.us with questions.
05Already effective August 1, 2026: Medically Unlikely Edits apply annual unit limits to H0038, H2014 and T1017, and procedure-to-procedure edits prevent billing overlapping or duplicative supportive services on the same date of service.
06The MUE edits do not apply to these codes for services under HCBS waivers, Community First Choice, or TCM services provided by Transition Coordination Agencies.
07Already effective July 1, 2026: CPT 97535 and 97537 will no longer reimburse.
08CPT 77063 cannot be billed as a stand-alone service, so bill it on the same claim as CPT 77067.
09Already effective July 1, 2026: Agencies and CDASS employers must monitor caregiver hours against the weekly limit of 84 hours through December 31, 2026, the weekly limit of 70 hours from January 1, 2027 through June 30, 2027, and 56 hours from July 1, 2027, coordinate with other providers serving the same member, maintain required documentation, and submit exception requests when applicable.
10Claims with more than 50 detail lines must be submitted, adjusted or voided through the EDI batch process, because the Provider Web Portal does not allow those actions above 50 lines.
11Already effective January 1, 2026: Pends and requests for information are not allowed on Expedited PARs, so include all documentation with the initial submission.
12Already effective July 1, 2026: The Rapid Review PAR type was eliminated, so make sure PARs submitted as Expedited Review meet the Expedited Review criteria.
13RPM services furnished by an RHC must be reimbursed through the RHC Prospective Payment System methodology, and RHCs should not bill RPM services separately for fee-for-service reimbursement.
14Historical deadline August 31, 2026: Trading partners were required to register on the Edifecs Trading Partner Enrollment and Testing Site.
Codes mentioned
H0004H0023H0025H0036H2014H2023H2024H2025H2026H2027H2032S5150S5151S9445S9453S9454T1017H0035H0037H0039H0040H2012H2033S9480T1005H2021H2022H2001H2015H2016H2017H2018H0045908769753597537H00387706377067
Original notice
Health First Colorado (Colorado's Medicaid Program) News and Updates (B2600540 - 07/2026)
hcpf.colorado.gov · Always check the source before changing claims.
Related changes
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Related policy hubs
Colorado Medicaid policiesCO policy changesCode H0004Code H0023Code H0025Code H0036Code H2014Code H2023Code H2024Code H2025Code H2026Code H2027Code H2032Code S5150Code S5151Code S9445Code S9453Code S9454Code T1017Code H0035Code H0037Code H0039Code H0040Code H2012Code H2033Code S9480Code T1005Code H2021Code H2022Code H2001Code H2015Code H2016Code H2017Code H2018Code H0045Code 90876Code 97535Code 97537Code H0038Code 77063Code 77067