- General Information
- Denver Minimum Wage Regional Pricing Overview
- Denver Minimum Wage Regional Pricing Procedure Codes
- HCBS Waiver Denver Procedure Code Tables
- HCBS-BI Denver Procedure Code Table
- HCBS-CES Denver Procedure Code Table
- HCBS-CHCBS Denver Procedure Code Table
- HCBS-CHRP Denver Procedure Code Table
- HCBS-CLLI Denver Procedure Code Table
- HCBS-CIH Denver Procedure Code Table
- HCBS-CMHS Denver Procedure Code Table
- HCBS-DD Denver Procedure Code Table
- HCBS-EBD Denver Procedure Code Table
- HCBS-SLS Denver Procedure Code Table
- HCBS-EBD Paper Claim Reference Table
- Timely Filing
- HCBS Denver Appendix Manual Revisions Log
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General Information: Home and Community Based Services (HCBS) Waivers and Prior Authorizations (PARs)
Home and Community-Based Services (HCBS) Waiver programs provide additional Health First Colorado (Colorado's Medicaid program) benefits to specific populations who meet special eligibility criteria.
Level of care (LOC) functional eligibility determinations are made annually by one of the Case Management Agencies (CMAs) in each of the 20 Defined Service Areas. Members must meet financial, medical, and program criteria to access services under a waiver. The applicant must be at risk of transition to either a nursing facility setting, or a hospital setting. To access waiver benefits, Members must be willing to receive services in their homes or communities. A Member who receives services through a waiver is also eligible for all basic Health First Colorado covered services except nursing facility and long-term hospital care. When a Member chooses to receive services under a waiver, the services must be provided by certified Health First Colorado Provider Agencies.
Applicants may apply for more than one waiver but may only receive services through one waiver at a time.
Unless otherwise noted, all HCBS services require prior approval before they can be reimbursed by Health First Colorado. Case Management Agencies (CMAs) complete the Prior Approval and/or Cost Containment requests for their specific programs according to instructions published in the regulations for the Department of Health Care Policy & Financing (the Department).
Approval of prior authorization does not guarantee Health First Colorado payment and does not serve as a timely filing waiver. Prior authorization only assures that the approved service is a medical necessity and is considered a benefit of the Health First Colorado. All claims, including those for prior authorized services, must meet eligibility and claim submission requirements (e.g., timely filing, Provider Agency information completed appropriately, required attachments included, etc.) before payment can be made.
Denver Minimum Wage Regional Pricing Overview
This Appendix provides guidance about, as well as only the services impacted by, Denver Minimum Wage Regional Pricing. Certain HCBS delivered to Members while they are within the city and county of Denver are eligible for higher reimbursement rates. Provider Agencies are required to comply with all guidance in the General Provider Information manual for general billing information, and to the specific HCBS billing manuals for each waiver, which contain additional, and specific, information about each waiver.
As background, Colorado Revised Statute at § 29-1-1401 repealed statewide prohibitions on regional differences in minimum wage amounts in Colorado. Leveraging this statute, the Denver City Council passed its own regional increase to minimum wages. Denver Council Bill 1237 (CB-1237) mandates city-wide, annual increases to the minimum wage beginning January 1, 2020, with subsequent increases based on the Consumer Price Index (CPI) starting in 2023. The Colorado General Assembly approved an increase to Provider Agency rates in the Long Bill (HB20- 1360) for some HCBS Provider Agencies. The rate increase approved is specifically targeted to Provider Agencies rendering services in the City and County of Denver (“Denver Minimum Wage Rate Increase”) beginning January 1, 2021.
Reference the Department’s HCBS fee schedules for a complete list of service codes/modifiers, and rates for each Fiscal Year relative to Denver Minimum Wage Regional Pricing.
Denver Minimum Wage Regional Pricing Procedure Codes
Effective January 1, 2025, specific service codes changed to allow for the reimbursement of all HCBS provided to Members while they are in the city and County of Denver on the day the service was, or services were, delivered. This appendix includes all services eligible for reimbursement relative to the Denver Minimum Wage Regional Pricing.
Provider Agencies must use the procedure code and modifier combinations in the tables below to ensure appropriate reimbursement for services delivered.
Provider Agencies are advised that the HX modifier will not be present on PAR lines verified in the Provider Portal or provided on documentation from Case Managers. Provider Agencies are to bill for services using the HX modifier if the service was provided to a Member while they were within the City and County of Denver. However, Provider Agencies billing for Consumer Directed Attendant Support Services (CDASS), Alternative Care Facility (ACF), or Supported Living Services (SLP), are required to leave off the HX modifier because the Denver Regional Pricing rate is authorized on the Prior Authorization, and built into the approved rate(s) for the service(s).
If billing for HCBS that do not have a Denver option listed in this manual, Provider Agencies must use procedure code and modifier combinations provided in the standard HCBS manuals.
Provider Agencies billing Denver-specific procedure code and modifier combinations for Members receiving services outside of the City and County of Denver are subject to claims review and/or audits to ensure compliance with the legislation.
Denver Regional Pricing
Certain HCBS delivered to Members while they are within the City and County of Denver are eligible for higher rates. Information relative to these services, and guidance on the applicability of these rates to certain services, can be found in the Denver Minimum Wage Pricing Appendix, on the Department’s billing manual page under “HCBS.”
HCBS Waiver Denver Procedure Code Tables
Brain Injury (HCBS-BI) Waiver Denver Regional Pricing Procedure Code Table
Description | Procedure Code | Modifier(s) | Unit Designation |
|---|---|---|---|
Mobility Van (Adult Day Services Transportation), Denver County | |||
| Mileage Band 1 (0-10 miles) | A0120 | U6, HB, HX | 1 Way Trip |
| Mileage Band 2 (11-20 miles) | A0120 | U6, TT, HB, HX | 1 Way Trip
|
| Mileage Band 3 (over 20 miles) | A0120 | U6, TN, HB, HX | 1 Way Trip
|
| Wheelchair Van (Adult Day Services Transportation), Denver County | |||
| Mileage Band 1 (0-10 miles) | A0130 | U6, HB, HX | 1 Way Trip |
| Mileage Band 2 (11-20 miles) | A0130 | U6, TT, HB, HX | 1 Way Trip |
| Mileage Band 3 (over 20 miles) | A0130 | U6, TN, HB, HX | 1 Way Trip |
Consumer Direct Attendant Supports and Services (CDASS), Denver County | |||
CDASS Homemaker | T2025 | 15 Minutes | |
CDASS Personal Care | T2025 | U6 | 15 Minutes |
CDASS Health Maintenance | T2025 | U6 | 15 Minutes |
Mobility Van (Non Medical), Denver County | |||
| Mileage Band 1 (0-10 miles) | A0120 | U6, HX | 1 Way Trip |
| Mileage Band 2 (11-20 miles) | A0120 | U6, TT, HX | 1 Way Trip
|
| Mileage Band 3 (over 20 miles) | A0120 | U6, TN, HX | 1 Way Trip
|
| Wheelchair Van (Non Medical), Denver County | |||
| Mileage Band 1 (0-10 miles) | A0130 | U6, HX | 1 Way Trip |
| Mileage Band 2 (11-20 miles) | A0130 | U6, TT, HX | 1 Way Trip |
| Mileage Band 3 (over 20 miles) | A0130 | U6, TN, HX | 1 Way Trip |
Personal Care Services, Denver County | |||
Personal Care | T1019 | U6, HX | 15 Minutes |
Personal Care, Relative | T1019 | U6, HR, HX | 15 Minutes |
Respite Care, Denver County | |||
In-Home Respite | S5150 | U6, HX | 15 Minutes |
Respite Care, Denver County | |||
In-Home Respite | S5150 | U6, HX | 15 Minutes |
Transitional Living Program, Denver County | |||
Transitional Living Program | T2016 | U6, HX | Day |
Tier 1 | T2033 | U6 | Day |
Tier 2 | T2033 | U6, HB | Day |
Tier 3 | T2033 | U6, HE | Day |
Tier 4 | T2033 | U6, HK | Day |
Tier 5 | T2033 | U6, HB, HE | Day |
Tier 6 | T2033 | U6, HB, HK | Day |
Tier 7 | T2033 | U6, HB, HK, SC | Day |
Back to HCBS-BI Standard Code Table
Children's Extensive Support (HCBS-CES) Waiver Denver Regional Pricing Procedure Code Table
Description | Procedure Code | Modifier(s) | Unit Designation |
|---|---|---|---|
Community Connector, Denver County | |||
Community Connector | H2021 | U7, HX | 15 Minutes |
Community Connector Parental Provision | H2021 | U7, HA, HX | 15 Minutes |
Homemaker, Denver County | |||
Basic | S5130 | U7, HX | 15 Minutes |
Enhanced | S5130 | U7, 22, HX | 15 Minutes |
Basic Parental Provision | S5130 | U7, HA, HI, HX | 15 Minutes |
Enhanced Parental Provision | S5130 | U7, HA, HX | 15 Minutes |
Respite, Denver County | |||
Unskilled Respite Services-Individual | S5150 | U7, HX | 15 Minutes |
Unskilled Respite Services-Individual | S5151 | U7, HX | Day |
Skilled CNA (4 hours or less) | T1005 | U7, HX | 15 Minutes |
Skilled CNA (4 hours or more) | S9125 | U7, HX | Day |
Skilled RN, LPN (4 hours or less) | T1005 | U7, TD, HX | 15 Minutes |
Skilled RN, LPN (4 hours or more) | S9125 | U7, TD, HX | Day |
| Skilled Therapeutic (4 hours or less) | T1005 | U7, HA, HX | 15 Minutes |
| Skilled Therapeutic (4 hours or less) | S9125 | U7, HA, HX | Day |
Back to HCBS-CES Standard Code Table
Children's Home and Community Based Services (HCBS-CHCBS) Waiver Denver Regional Pricing Procedure Code Table
Description | Procedure Code | Modifier(s) | Unit Designation |
|---|---|---|---|
IHSS Health Maintenance, Denver County | |||
| IHSS Health Maintenance | H0038 | U5, HX | 15 Minutes |
Back to IHSS Standard Rate Table
Children’s Habilitation Residential Program Waiver (HCBS-CHRP) Denver Regional Pricing Procedure Code Table
Description | Procedure Code | Modifier(s) | Unit Designation |
|---|---|---|---|
| Foster Home – Denver County | |||
Foster Home Level 1 | H0041 | U9, HX | Day |
Foster Home Level 2 | H0041 | U9, 22, HX | Day |
Foster Home Level 3 | H0041 | U9, TF, HX | Day |
Foster Home Level 4 | H0041 | U9, TF, 22, HX | Day |
Foster Home Level 5 | H0041 | U9, TG, HX | Day |
Foster Home Level 6 | H0041 | U9, TG, 22, HX | Day |
Habilitation - Group Home – Denver County | |||
Group Home - Level 1 | T2016 | U9, HX | Day |
Group Home - Level 2 | T2016 | U9, 22, HX | Day |
Group Home - Level 3 | T2016 | U9, TF, HX | Day |
Group Home - Level 4 | T2016 | U9, TF, 22, HX | Day |
Group Home - Level 5 | T2016 | U9, TG, HX | Day |
Group Home - Level 6 | T2016 | U9, TG, 22, HX | Day |
Respite Care – Denver County | |||
Unskilled Individual – in the Family Home | S5150 | U9, HA, HX | 15 Minutes |
Unskilled Individual Day – in the Family Home | S5151 | U9, HA, HX | Day |
Skilled Respite – Denver County | |||
Skilled CNA (4 hours or less) | T1005 | U9, HX | 15 Minutes |
Skilled RN, LPN (4 hours or less) | T1005 | U9, TD, HX | 15 Minutes |
Skilled CNA (4 hours or more) | S9125 | U9 HX | Day |
Skilled RN, LPN (4 hours or more) | S9125 | U9, TD, HX | Day |
| CHRP Youth Mentorship-CES/CHRP Therapeutic Respite – Denver County | |||
| Skilled Therapeutic (4 hours or less) | T1005 | U9, HA, HX | 15 Minutes |
| Skilled Therapeutic (4 hours or more) | S9125 | U9, HA, HX | Day |
Community Connector – Denver County | |||
| Community Connector | H2021 | U9, HX | 15 Minutes |
| Community Connector Parental Provision | H2021 | U9, HA, HX | 15 Minutes |
Back to HCBS-CHRP Standard Rates Table
Children with Life Limiting Illness (HCBS-CLLI) Waiver Denver Regional Pricing Procedure Code Table
Description | Procedure Code | Modifier(s) | Unit Designation |
|---|---|---|---|
Respite Services, Outside Denver County | |||
| Unskilled (4 hours or less) | S5150 | UD, HX | 15 Minutes |
| Unskilled (4 hours or more) | S5151 | UD, HX | Day |
| CNA (4 hours or less) | T1005 | UD, HX | 15 Minutes |
| CNA (4 hours or more) | S9125 | UD, HX | Day |
Skilled RN, LPN (4 hours or less) | T1005 | UD, TD, HX | 15 Minutes |
Skilled RN, LPN (4 hours or more) | S9125 | UD, TD, HX | Day |
Camp (Group, Overnight) | T2037 | UD, HX | Day |
Back to HCBS-CLLI Standard Table
Complementary & Integrative Health (HCBS-CIH) Waiver Denver Regional Pricing Procedure Code Table
Description | Procedure Code | Modifier(s) | Unit Designation |
|---|---|---|---|
Adult Day Services, Denver County | |||
| Basic | S5100 | U1, SC, HX | 15 Minutes |
| Basic | S5105 | U1, SC, HX | ½ Day |
| Specialized | S5105 | U1, SC, TF, HX | ½ Day |
Mobility Van (Adult Day Program Transportation), Denver County | |||
Mileage Band 1 (0-10 miles) | A0120 | U1, SC, HB, HX | 1 Way Trip |
Mileage Band 2 (11-20 miles) | A0120 | U1, SC, ST, HX | 1 Way Trip |
| Mileage Band 3 (over 20 miles) | A0120 | U1, SC, TU, HX | 1 Way Trip |
Wheelchair Van (Adult Day Program Transportation), Denver County | |||
Mileage Band 1 (0-10 miles) | A0130 | U1, SC, HB, HX | 1 Way Trip |
Mileage Band 2 (11-20 miles) | A0130 | U1, SC, ST, HX | 1 Way Trip |
| Mileage Band 3 (over 20 miles) | A0130 | U1, SC, TU, HX | 1 Way Trip |
Consumer Directed Attendant Support Services (CDASS), Denver County | |||
| CDASS Homemaker | T2025 | U1, SC | 15 Minutes |
| CDASS Personal Care | T2025 | U1, SC | 15 Minutes |
| CDASS Health Maintenance | T2025 | U1, SC | 15 Minutes |
| Homemaker Services, Denver County | |||
| Homemaker | S5130 | U1, SC, HX | 15 Minutes |
In-Home Support Services (IHSS), Denver County | |||
IHSS Health Maintenance | H0038 | U1, SC, HX | 15 Minutes |
IHSS Homemaker | S5130 | U1, SC, KX, HX | 15 Minutes |
IHSS Personal Care | T1019 | U1, SC, KX, HX | 15 Minutes |
IHSS Relative Personal Care | T1019 | U1, SC, TF, HX | 15 Minutes |
Mobility Van (Non Medical), Denver County | |||
Mileage Band 1 (0-10 miles) | A0120 | U1, SC, HX | 1 Way Trip |
Mileage Band 2 (11-20 miles) | A0120 | U1, SC, TT, HX | 1 Way Trip |
| Mileage Band 3 (over 20 miles) | A0120 | U1, SC, TN, HX | 1 Way Trip |
Wheelchair Van (Non Medical), Denver County | |||
Mileage Band 1 (0-10 miles) | A0130 | U1, SC, HX | 1 Way Trip |
Mileage Band 2 (11-20 miles) | A0130 | U1, SC, TT, HX | 1 Way Trip |
| Mileage Band 3 (over 20 miles) | A0130 | U1, SC, TN, HX | 1 Way Trip |
Personal Care Services, Denver County | |||
Personal Care | T1019 | U1, SC, HX | 15 Minutes |
Relative Personal Care | T1019 | U1, SC, HR, HX | 15 Minutes |
Respite Care, Denver County | |||
ACF (Alternative Care Facility) | S5151 | U1, SC, HX | Day |
In-Home Respite | S5150 | U1, SC, HX | 15 Minutes |
Return to CIH Standard Procedure Code Table
Community Mental Health Supports (HCBS-CMHS) Waiver Denver Regional Pricing Procedure Code Table
Description | Procedure Code | Modifier(s) | Unit Designation |
|---|---|---|---|
Adult Day Services, Denver County | |||
| Basic | S5100 | UA, HX | 15 Minutes |
| Basic | S5105 | UA, HX | ½ Day |
| Specialized | S5105 | UA, TF, HX | ½ Day |
Mobility Van (Adult Day Program Transportation), Denver County | |||
Mileage Band 1 (0-10 miles) | A0120 | UA, HB, HX | 1 Way Trip |
Mileage Band 2 (11-20 miles) | A0120 | UA, TT, HB, HX | 1 Way Trip |
| Mileage Band 3 (over 20 miles) | A0120 | UA, TN, HB, HX | 1 Way Trip |
Wheelchair Van (Adult Day Program Transportation), Denver County | |||
Mileage Band 1 (0-10 miles) | A0130 | UA, HB, HX | 1 Way Trip |
Mileage Band 2 (11-20 miles) | A0130 | UA, TT, HB, HX | 1 Way Trip |
| Mileage Band 3 (over 20 miles) | A0130 | UA, TN, HB, HX | 1 Way Trip |
| Alternative Care Facility | T2031 | UA | Day |
Consumer Directed Attendant Support Services (CDASS), Denver County | |||
| CDASS Homemaker | T2025 | UA | 15 Minutes |
| CDASS Personal Care | T2025 | UA | 15 Minutes |
| CDASS Health Maintenance | T2025 | UA | 15 Minutes |
| Homemaker Services, Denver County | |||
| Homemaker | S5130 | UA, HX | 15 Minutes |
Mobility Van (Non Medical), Denver County | |||
Mileage Band 1 (0-10 miles) | A0120 | UA, HX | 1 Way Trip |
Mileage Band 2 (11-20 miles) | A0120 | UA, TT, HX | 1 Way Trip |
| Mileage Band 3 (over 20 miles) | A0120 | UA, TN, HX | 1 Way Trip |
Wheelchair Van (Non Medial), Denver County | |||
Mileage Band 1 (0-10 miles) | A0130 | UA, HX | 1 Way Trip |
Mileage Band 2 (11-20 miles) | A0130 | UA, TT, HX | 1 Way Trip |
| Mileage Band 3 (over 20 miles) | A0130 | UA, TN, HX | 1 Way Trip |
Personal Care Services, Denver County | |||
Personal Care | T1019 | UA, HX | 15 Minutes |
Personal Care, Relative | T1019 | UA, HR, HX | 15 Minutes |
Respite Care, Denver County | |||
ACF (Alternative Care Facility) | S5151 | UA, HX | Day |
Back to HCBS-CMHS Standard Procedure Code Table
Persons with Developmental Disabilities (HCBS-DD) Waiver Denver Regional Pricing Procedure Code Table
Description | Procedure Code | Modifier(s) | Unit Designation |
|---|---|---|---|
Specialized Habilitation – Tier 1 & 2, Denver County | |||
Specialized Habilitation – Level 1 | T2021 | U3, HQ, HX | 15 Minutes |
Specialized Habilitation – Level 2 | T2021 | U3, 22, HQ, HX | 15 Minutes |
Specialized Habilitation – Level 3 | T2021 | U3, TF, HQ, HX | 15 Minutes |
Specialized Habilitation – Level 4 | T2021 | U3, TF, ST, HX | 15 Minutes |
Specialized Habilitation – Level 5 | T2021 | U3, TG, HQ, HX | 15 Minutes |
Specialized Habilitation – Level 6 | T2021 | U3, TG, ST, HX | 15 Minutes |
Specialized Habilitation – Level 7 | T2021 | U3, SC, HQ, HX | 15 Minutes |
Supported Community Connections – Tier 1 & 2, Denver County | |||
Supported Community Connections – Level 1 | T2021 | U3, HX | 15 Minutes |
Supported Community Connections – Level 2 | T2021 | U3, 22, HX | 15 Minutes |
Supported Community Connections – Level 3 | T2021 | U3, TF, HX | 15 Minutes |
Supported Community Connections – Level 4 | T2021 | U3, TF, 22, HX | 15 Minutes |
Supported Community Connections – Level 5 | T2021 | U3, TG, HX | 15 Minutes |
Supported Community Connections – Level 6 | T2021 | U3, TG, 22, HX | 15 Minutes |
Supported Community Connections – Level 7 | T2021 | U3 SC HX | 15 Minutes |
Non-Medical Transportation, Denver County | |||
Mileage Band 1 (0-10 miles) | T2003 | U3, HX | 1 Way Trip |
Mileage Band 1 (11-20 miles) | T2003 | U3, 22, HX | 1 Way Trip |
Mileage Band 1 (Over 20 miles) | T2003 | U3, TF, HX | 1 Way Trip |
Prevocational Services, Denver County | |||
Prevocational Services – Level 1 | T2015 | U3, HQ, HX | 15 Minutes |
Prevocational Services – Level 2 | T2015 | U3, 22, HQ, HX | 15 Minutes |
Prevocational Services – Level 3 | T2015 | U3, TF, HQ, HX | 15 Minutes |
Prevocational Services – Level 4 | T2015 | U3, TF, 22, HX | 15 Minutes |
Prevocational Services – Level 5 | T2015 | U3, TG, HQ, HX | 15 Minutes |
Prevocational Services – Level 6 | T2015 | U3, TG, 22, HX | 15 Minutes |
Residential Habilitation, Denver County | |||
Group Residential Services and Supports – Level 1 | T2016 | U3, HQ, HX | Day |
Group Residential Services and Supports – Level 2 | T2016 | U3, 22, HQ, HX | Day
|
Group Residential Services and Supports – Level 3 | T2016 | U3, TF, HQ, HX | Day |
Group Residential Services and Supports – Level 4 | T2016 | U3, TF, ST, HX | Day |
Group Residential Services and Supports – Level 5 | T2016 | U3, TG, HQ, HX | Day |
Group Residential Services and Supports – Level 6 | T2016 | U3, TG, ST, HX | Day |
Individual Residential Services and Supports – Level 1 | T2016 | U3, HX | Day |
Individual Residential Services and Supports – Level 2 | T2016 | U3, 22, HX | Day |
Individual Residential Services and Supports – Level 3 | T2016 | U3, TF, HX | Day |
Supported Community Connections – Level 4 | T2016 | U3, TF, 22, HX | Day |
Individual Residential Services and Supports – Level 5 | T2016 | U3, TG, HX | Day |
Individual Residential Services and Supports – Level 6 | T2016 | U3, TG, 22, HX | Day |
Individual Residential Services and Supports/Host Home – Level 1 | T2016 | U3, TT, HX | Day |
Individual Residential Services and Supports/Host Home – Level 2 | T2016 | U3, 22, TT, HX | Day |
Individual Residential Services and Supports/Host Home – Level 3 | T2016 | U3, TF, TT, HX | Day |
Individual Residential Services and Supports/Host Home – Level 4 | T2016 | U3, TF, TU, HX | Day |
Individual Residential Services and Supports/Host Home – Level 5 | T2016 | U3, TG, TT, HX | Day |
Individual Residential Services and Supports/Host Home – Level 6 | T2016 | U3, TG, TU, HX | Day |
Supported Employment, Denver County | |||
Job Coaching, Group – Level 1 | T2019 | U3, HQ, HX | 15 Minutes |
Job Coaching, Group – Level 2 | T2019 | U3, 22, HQ, HX | 15 Minutes |
Job Coaching, Group – Level 3 | T2019 | U3, TF, HQ, HX | 15 Minutes |
Job Coaching, Group – Level 4 | T2019 | U3, TF, 22, HX | 15 Minutes |
Job Coaching, Group – Level 5 | T2019 | U3, TG, HQ, HX | 15 Minutes |
Job Coaching, Group – Level 6 | T2019 | U3, TG, 22, HX | 15 Minutes |
Job Coaching, Individual | T2019 | U3, SC, HX | 15 Minutes |
Job Development, Group | H2023 | U3, HQ, HX | 15 Minutes |
Job Development, Individual - Levels 1-2 | H2023 | U3, HX | 15 Minutes |
Job Development, Individual - Levels 3-4 | H2023 | U3, 22, HX | 15 Minutes |
Job Development, Individual - Levels 5-6 | H2023 | U3, TF, HX | 15 Minutes |
Workplace Assistance | T2019 | U3, HB | 15 Minutes |
Back to HCBS-DD Standard Procedure Code Table
Elderly, Blind and Disabled (HCBS-EBD) Waiver Denver Regional Pricing Procedure Code Table
Description | Procedure Code | Modifier(s) | Unit Designation |
|---|---|---|---|
Adult Day Services, Denver County | |||
| Basic | S5100 | U1, HX | 15 Minutes |
| Basic | S5105 | U1, HX | ½ Day |
| Specialized | S5105 | U1, TF, HX | ½ Day |
Mobility Van (Adult Day Program Transportation), Denver County | |||
Mileage Band 1 (0-10 miles) | A0120 | U1, HB, HX | 1 Way Trip |
Mileage Band 2 (11-20 miles) | A0120 | U1, TT, HB, HX | 1 Way Trip |
| Mileage Band 3 (over 20 miles) | A0120 | U1, TN, HB, HX | 1 Way Trip |
Wheelchair Van (Adult Day Program Transportation), Denver County | |||
Mileage Band 1 (0-10 miles) | A0130 | U1, HB, HX | 1 Way Trip |
Mileage Band 2 (11-20 miles) | A0130 | U1, TT, HB, HX | 1 Way Trip |
| Mileage Band 3 (over 20 miles) | A0130 | U1, TN, HB, HX | 1 Way Trip |
| Alternative Care Facility | T2031 | U1 | Day |
Consumer Directed Attendant Support Services (CDASS), Denver County | |||
| CDASS Homemaker | T2025 | U1 | 15 Minutes |
| CDASS Personal Care | T2025 | U1 | 15 Minutes |
| CDASS Health Maintenance | T2025 | U1 | 15 Minutes |
| Homemaker Services, Denver County | |||
| Homemaker | S5130 | U1, HX | 15 Minutes |
In Home Support Services (IHSS), Denver County | |||
| IHSS Health Maintenance | H0038 | U1, HX | 15 Minutes |
| IHSS Homemaker | S5130 | U1, KX, HX | 15 Minutes |
| IHSS Personal Care | T1019 | U1, KX, HX | 15 Minutes |
| IHSS Relative Personal Care | T1019 | U1, HR, KX, HX | 15 Minutes |
Mobility Van (Non Medical), Denver County | |||
Mileage Band 1 (0-10 miles) | A0120 | U1, HX | 1 Way Trip |
Mileage Band 2 (11-20 miles) | A0120 | U1, TT, HX | 1 Way Trip |
| Mileage Band 3 (over 20 miles) | A0120 | U1, TN, HX | 1 Way Trip |
Wheelchair Van (Non Medial), Denver County | |||
Mileage Band 1 (0-10 miles) | A0130 | U1, HX | 1 Way Trip |
Mileage Band 2 (11-20 miles) | A0130 | U1, TT, HX | 1 Way Trip |
| Mileage Band 3 (over 20 miles) | A0130 | U1, TN, HX | 1 Way Trip |
Personal Care Services, Denver County | |||
Personal Care | T1019 | U1, HX | 15 Minutes |
Personal Care, Relative | T1019 | U1, HR, HX | 15 Minutes |
Respite Care, Denver County | |||
ACF (Alternative Care Facility) | S5151 | U1, HX | Day |
| In-Home Respite | S5150 | U1, HX | 15 Minutes |
Back to EBD Standard Procedure Code Table
Supported Living Services (HCBS-SLS) Waiver Denver Regional Pricing Procedure Code Table
Consumer Directed Attendant Support Services (CDASS), Denver County | |||
CDASS Homemaker | T2025 | U8 | 15 Minutes |
CDASS Enhanced Homemaker | T2025 | U8 | 15 Minutes |
CDASS Personal Care | T2025 | U8 | 15 Minutes |
CDASS Health Maintenance | T2025 | U8, SE | 15 Minutes |
Specialized Habilitation – Tier 1 & 2, Denver County | |||
Specialized Habilitation – Level 1 | T2021 | U8, HQ, HX | 15 Minutes |
Specialized Habilitation – Level 2 | T2021 | U8, 22, HQ, HX | 15 Minutes |
Specialized Habilitation – Level 3 | T2021 | U8, TF, HQ, HX | 15 Minutes |
Specialized Habilitation – Level 4 | T2021 | U8, TF, TU, HX | 15 Minutes |
Specialized Habilitation – Level 5 | T2021 | U8, TG, HQ, HX | 15 Minutes |
Specialized Habilitation – Level 6 | T2021 | U3, TG, TU, HX | 15 Minutes |
Supported Community Connections – Tier 1 & 2, Denver County | |||
Supported Community Connections – Level 1 | T2021 | U8, HX | 15 Minutes |
Supported Community Connections – Level 2 | T2021 | U8, 22, HX | 15 Minutes |
Supported Community Connections – Level 3 | T2021 | U8, TF, HX | 15 Minutes |
Supported Community Connections – Level 4 | T2021 | U8, TF, 22, HX | 15 Minutes |
Supported Community Connections – Level 5 | T2021 | U8, TG, HX | 15 Minutes |
Supported Community Connections – Level 6 | T2021 | U8, TG, 22, HX | 15 Minutes |
Homemaker, Denver County | |||
Basic | S5130 | U8, HX | 15 Minutes |
Enhanced | S5130 | U8, 22, HX | 15 Minutes |
Mentorship, Denver County | |||
Mentorship | H2021 | U8, HX | 15 Minutes |
Non-Medical Transportation, Denver County | |||
Mileage Band 1 (0-10 miles) | T2003 | U8, HX | 1 Way Trip |
Mileage Band 1 (11-20 miles) | T2003 | U8, 22, HX | 1 Way Trip |
Mileage Band 1 (Over 20 miles) | T2003 | U8, TF, HX | 1 Way Trip |
Personal Care Services, Denver County | |||
Personal Care | T1019 | U8, HX | 15 Minutes |
Prevocational Services, Denver County | |||
Prevocational Services – Level 1 | T2015 | U8, HQ, HX | 15 Minutes |
Prevocational Services – Level 2 | T2015 | U8, 22, HQ, HX | 15 Minutes |
Prevocational Services – Level 3 | T2015 | U8, TF, HQ, HX | 15 Minutes |
Prevocational Services – Level 4 | T2015 | U8, TF, 22, HX | 15 Minutes |
Prevocational Services – Level 5 | T2015 | U8, TG, HQ, HX | 15 Minutes |
Prevocational Services – Level 6 | T2015 | U8, TG, 22, HX | 15 Minutes |
Respite Care, Denver County | |||
Individual | S5150 | U8, HX | 15 Minutes |
Individual Day | S5151 | U8, HX | Day |
Supported Employment, Denver County | |||
Job Coaching, Group – Level 1 | T2019 | U8, HQ, HX | 15 Minutes |
Job Coaching, Group – Level 2 | T2019 | U8, 22, HQ, HX | 15 Minutes |
Job Coaching, Group – Level 3 | T2019 | U8, TF, HQ, HX | 15 Minutes |
Job Coaching, Group – Level 4 | T2019 | U8, TF, 22, HX | 15 Minutes |
Job Coaching, Group – Level 5 | T2019 | U8, TG, HQ, HX | 15 Minutes |
Job Coaching, Group – Level 6 | T2019 | U8, TG, 22, HX | 15 Minutes |
Job Coaching, Individual | T2019 | U8, SC, HX | 15 Minutes |
Job Development, Group | H2023 | U8, HQ, HX | 15 Minutes |
Job Development, Individual -
Levels 1-2 | H2023 | U8, HX | 15 Minutes |
Job Development, Individual - Levels 3-4 | H2023 | U8, 22, HX | 15 Minutes |
| Job Development, Individual Levels 5-6 | H2023 | U8, TF, HX | 15 Minutes |
Workplace Assistance | T2019 | U8, HB | 15 Minutes |
Back to Supported Living Services Standard Procedure Code Table
HCBS-EBD Paper Claim Reference Table
The following paper form reference table gives required and/or conditional fields for the paper CMS 1500 claim form for HCBS-EBD claims:
| CMS Field Number and Label | Field is? | Instructions | ||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1. Insurance Type | Required | Place an "X" in the box marked as Medicaid. | ||||||||||||||||||||||||||||||||||||
| 1a. Insured's ID Number | Required | Enter the Member's Health First Colorado seven-digit ID number as it appears on the Health First Colorado Identification card. Example: A123456. | ||||||||||||||||||||||||||||||||||||
| 2. Patient's Name | Required | Enter the Member's last name, first name, and middle initial. | ||||||||||||||||||||||||||||||||||||
| 3. Patient's Date of Birth/Sex | Required | Enter the Member's birth date using two digits for the month, two digits for the date, and two digits for the year. Example: 070114 for July 1, 2014. Place an "X" in the appropriate box to indicate the sex of the Member. | ||||||||||||||||||||||||||||||||||||
| 4. Insured's Name | Not required | |||||||||||||||||||||||||||||||||||||
| 5. Patient's Address | Not Required | |||||||||||||||||||||||||||||||||||||
| 6. Client Relationship to Insured | Not Required | |||||||||||||||||||||||||||||||||||||
| 7. Insured's Address | Not Required | |||||||||||||||||||||||||||||||||||||
| 8. Reserved for NUCC Use | Not Required | |||||||||||||||||||||||||||||||||||||
| 9. Other Insured's Name | Not Required | |||||||||||||||||||||||||||||||||||||
| 9a. Other Insured's Policy or Group Number | Not Required | |||||||||||||||||||||||||||||||||||||
| 9b. Reserved for NUCC Use | ||||||||||||||||||||||||||||||||||||||
| 9c. Reserved for NUCC Use | ||||||||||||||||||||||||||||||||||||||
| 9d. Insurance Plan or Program Name | Not Required | |||||||||||||||||||||||||||||||||||||
| 10a-c. Is patient's condition related to? | Not Required | |||||||||||||||||||||||||||||||||||||
| 10d. Reserved for Local Use | ||||||||||||||||||||||||||||||||||||||
| 11. Insured's Policy, Group or FECA Number | Not Required | |||||||||||||||||||||||||||||||||||||
| 11a. Insured's Date of Birth, Sex | Not Required | |||||||||||||||||||||||||||||||||||||
| 11b. Other Claim ID | Not Required | |||||||||||||||||||||||||||||||||||||
| 11c. Insurance Plan Name or Program Name | Not Required | |||||||||||||||||||||||||||||||||||||
| 11d. Is there another Health Benefit Plan? | Not Required | |||||||||||||||||||||||||||||||||||||
| 12. Patient's or Authorized Person's signature | Required | Enter "Signature on File", "SOF", or legal signature. If there is no signature on file, leave blank or enter "No Signature on File". Enter the date the claim form was signed. | ||||||||||||||||||||||||||||||||||||
| 13. Insured's or Authorized Person's Signature | Not Required | |||||||||||||||||||||||||||||||||||||
| 14. Date of Current Illness Injury or Pregnancy | Not Required | |||||||||||||||||||||||||||||||||||||
| 15. Other Date | Not Required | |||||||||||||||||||||||||||||||||||||
| 16. Date Patient Unable to Work in Current Occupation | Not Required | |||||||||||||||||||||||||||||||||||||
| 17. Name of Referring Physician | Conditional | |||||||||||||||||||||||||||||||||||||
| 18. Hospitalization Dates Related to Current Service | Not Required | |||||||||||||||||||||||||||||||||||||
| 19. Additional Claim Information | Conditional | |||||||||||||||||||||||||||||||||||||
| 20. Outside Lab? $ Charges | Not Required | |||||||||||||||||||||||||||||||||||||
| 21. Diagnosis or Nature of Illness or Injury | Required | Enter at least one but no more than twelve diagnosis codes based on the Member's diagnosis/condition. Enter applicable ICD-10 indicator. HCBS HCBS may use R69. | ||||||||||||||||||||||||||||||||||||
| 22. Medicaid Resubmission Code | Conditional | List the original reference number for resubmitted claims. When resubmitting a claim, enter the appropriate bill frequency code in the left- hand side of the field. 7 - Replacement of prior claim 8 - Void/Cancel of prior claim This field is not intended for use for original claim submissions. | ||||||||||||||||||||||||||||||||||||
| 23. Prior Authorization | Not Required | |||||||||||||||||||||||||||||||||||||
| 24. Claim Line Detail | Information | The paper claim form allows entry of up to six detailed billing lines. Fields 24A through 24J apply to each billed line. Do not enter more than six lines of information on the paper claim. If more than six lines of information are entered, the additional lines will not be entered for processing. Each claim form must be fully completed (totaled). Do not file continuation claims (e.g., Page 1 of 2). | ||||||||||||||||||||||||||||||||||||
| 24A. Dates of Service | Required | The field accommodates the entry of two dates: a "From" date of services and a "To" date of service. Enter the date of service using two digits for the month, two digits for the date and two digits for the year. Example: 010116 for January 1, 2016.
or
Span dates of service
Practitioner claims must be consecutive days. | ||||||||||||||||||||||||||||||||||||
| 24B. Place of Service | Required | Enter the Place of Service (POS) code that describes the location where services were rendered. Health First Colorado accepts the CMS place of service codes.
Note: Use POS Code 12 (Home) for Alternative Care Facility, Adult Day Program, or Respite in the Facility | ||||||||||||||||||||||||||||||||||||
| 24C. EMG | Not Required | |||||||||||||||||||||||||||||||||||||
| 24D. Procedures, Services, or Supplies | Required | Enter the HCPCS procedure code that specifically describes the service for which payment is requested. HCBS Refer to the HCBS-EBD or HCBS-CMHS procedure code tables. | ||||||||||||||||||||||||||||||||||||
| 24D. Modifier | Conditional | Enter the appropriate procedure-related modifier that applies to the billed service. Up to four modifiers may be entered when using the paper claim form. HCBS Refer to the HCBS-EBD or HCBS-CMHS procedure code tables. | ||||||||||||||||||||||||||||||||||||
| 24E. Diagnosis Pointer | Required | Enter the diagnosis code reference letter (A-L) that relates the date of service and the procedures performed to the primary diagnosis. At least one diagnosis code reference letter must be entered. When multiple services are performed, the primary reference letter for each service should be listed first, other applicable services should follow. This field allows for the entry of 4 characters in the unshaded area. | ||||||||||||||||||||||||||||||||||||
| 24F. $ Charges | Required | Enter the usual and customary charge for the service represented by the procedure code on the detail line. Do not use commas when reporting dollar amounts. Enter 00 in the cents area if the amount is a whole number. Some CPT procedure codes are grouped with other related CPT procedure codes. When more than one procedure from the same group is billed, special multiple pricing rules apply. The base procedure is the procedure with the highest allowable amount. The base code is used to determine the allowable amounts for additional CPT surgical procedures when more than one procedure from the same grouping is performed. Submitted charges cannot be more than charges made to non-Health First Colorado covered individuals for the same service. Do not deduct Health First Colorado co- payment or commercial insurance payments from the usual and customary charges. | ||||||||||||||||||||||||||||||||||||
| 24G. Days or Units | Required | Enter the number of services provided for each procedure code. Enter whole numbers only- do not enter fractions or decimals. | ||||||||||||||||||||||||||||||||||||
| 24G. Days or Units | General Instructions | A unit represents the number of times the described procedure or service was rendered. Except as instructed in this manual or in Health First Colorado bulletins, the billed unit must correspond to procedure code descriptions. The following examples show the relationship between the procedure description and the entry of units. Home and Community Based Services Combine units of services for a single procedure code for the billed time period on one detail line. Dates of service do not have to be reported separately. Example: If forty units of personal care services were provided on various days throughout the month of January, bill the personal care procedure code with a From Date of 01/03/XX and a To Date of 01/31/XX and 40 units. | ||||||||||||||||||||||||||||||||||||
| 24H. EPSDT/Family Plan | Not Required | |||||||||||||||||||||||||||||||||||||
| 24I. ID Qualifier | Not Required | |||||||||||||||||||||||||||||||||||||
| 24J. Rendering Provider ID # | Required | In the shaded portion of the field, enter the NPI of the Health First Colorado Provider Agency number assigned to the individual who actually performed or rendered the billed service. This number cannot be assigned to a group or clinic. | ||||||||||||||||||||||||||||||||||||
| 25. Federal Tax ID Number | Not Required | |||||||||||||||||||||||||||||||||||||
| 26. Patient's Account Number | Optional | Enter information that identifies the Member or claim in the Provider Agency's billing system. Submitted information appears on the Remittance Advice (RA). | ||||||||||||||||||||||||||||||||||||
| 27. Accept Assignment? | Required | The accept assignment indicates that the Provider Agency agrees to accept assignment under the terms of the payer's program. | ||||||||||||||||||||||||||||||||||||
| 28. Total Charge | Required | Enter the sum of all charges listed in field 24F. Do not use commas when reporting dollar amounts. Enter 00 in the cents area if the amount is a whole number. | ||||||||||||||||||||||||||||||||||||
| 29. Amount Paid | Not Required | |||||||||||||||||||||||||||||||||||||
| 30. Rsvd for NUCC Use | ||||||||||||||||||||||||||||||||||||||
| 31. Signature of Physician or Supplier Including Degrees or Credentials | Required | Each claim must bear the signature of the enrolled Provider Agency or the signature of a registered authorized agent. Each claim must have the date the enrolled Provider Agency or registered authorized agent signed the claim form. Enter the date the claim was signed using two digits for the month, two digits for the date and two digits for the year. Example: 070116 for July 1, 2016. | ||||||||||||||||||||||||||||||||||||
| 32. 32- Service Facility Location Information 32a- NPI Number 32b- Other ID # | Conditional | Enter the name, address and ZIP code of the individual or business where the Member was seen or service was performed in the following format: 1st Line Name 2nd Line Address 3rd Line City, State and ZIP Code If the Provider Type is not able to obtain an NPI, enter the eight-digit Health First Colorado Provider number of the individual or organization. | ||||||||||||||||||||||||||||||||||||
| 33. Billing Provider Info & Ph # | Required | Enter the name of the individual or organization that will receive payment for the billed services in the following format: 1st Line Name 2nd Line Address 3rd Line City, State and ZIP Code | ||||||||||||||||||||||||||||||||||||
| 33a- NPI Number | Required | |||||||||||||||||||||||||||||||||||||
| 33b- Other ID # | If the Provider Type is not able to obtain an NPI, enter the eight-digit Health First Colorado Provider Agency number of the individual or organization. | |||||||||||||||||||||||||||||||||||||
Timely Filing
Refer to the General Provider Information Manual located on the Billing Manuals web page under the General Provider Information drop-down for more information on timely filing policy, including the resubmission rules for denied claims.
HCBS Denver Appendix Revision Log
| Revision Date | Addition/Changes | Made by |
|---|---|---|
| 12/05/2024 | Creation of manual | HCPF |