Billing Manuals

Which billing manual should I use based on my provider type?

General Provider Information

• General Provider Information (7/23)

Managed Care Encounters Reporting Guide

• Managed Care Encounters Reporting Guide (3/23)

Appendices

• Appendix A - Colorado Department of Health Care Policy and Financing (6/22)
• Appendix B - Colorado Medical Assistance Program Fiscal Agent (6/22)
• Appendix C - Prior Authorization and Review Agencies (6/22)
• Appendix D - Programs, Services and Authorizing Agencies (6/22)
• Appendix E - County Departments of Human and Social Services (2/19)
• Appendix F - Border Towns (6/22)
• Appendix G -Outpatient Hospital Unbundled Durable Medical Equipment Codes (1/23)
• Appendix I - Provider Participation Agreement (6/22)
• Appendix M - Procedures Requiring Prior Authorization (4/19) Review the Health First Colorado fee schedule to see if a PAR is required for the procedure code.
• Appendix N - Prior Authorization Request Denial Reasons (5/17)
• Appendix O - EAPG Inpatient Only List (1/23)
• Appendix P - Pharmacy Benefit Prior Authorization Procedures and Criteria (2/19)
• Appendix Q - Revenue Codes (7/21)
• Appendix R - Remittance Advice (RA) Messages (7/23)
• Appendix S - RA Expenditure Reason Codes (12/18)
• Appendix T - Capitated Behavioral Health Program - please review Appendix C of the State Behavioral Health Services Billing Manual found on the Accountable Care Collaborative Phase II - Provider and Stakeholder Resource Center under Behavioral Health Services.
• Appendix U - Forms - No longer active, please see Forms button at bottom of page
• Appendix V -Terms, Acronyms and Abbreviations (6/18)
• Appendix W - No longer active
• Appendix X - HCPCS and NDC Crosswalk for Billing Physician-Administered Drugs (10/23)
• Appendix Y - Physician Administered Drug Medical Benefit Prior Authorization Procedures and Criteria  (12/21) (Located under Fee for Service Physician Administered Drugs dropdown menu)
• Appendix Z - Outpatient Hospital Specialty Drugs (9/23)

CMS 1500 (Professional)

• Ambulatory Surgery Centers (ASC) (5/23)
• Audiology (5/23)
• Behavioral Health Secure Transportation (6/23)
• Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) (7/23)
  • DMEPOS HCPCS Codes
  • Wheelchair Benefit Coverage Policy
• Early Intervention Program (12/22)
• Family Planning Benefit Expansion for Special Populations (8/23)
• Gender-Affirming Care Services (8/23)
• Immunization Benefits (8/23)
• Laboratory Services (8/23)
• Managed Care (10/22)
• Medical and Surgical Services (4/23)
• Nurse Home Visitor Program (NHVP) (9/20)
• Obstetrical Care (9/23)
• Outpatient Behavioral Health FFS (3/23)
• Outpatient Imaging and Radiology (8/23)
• Program of All-Inclusive Care for the Elderly (PACE) (4/21)
• Pediatric Behavioral Therapy (1/23)
• Pediatric Personal Care (12/20)
• Pharmacist Services Billing Manual (9/23)
• Physical and Occupational Therapy (PT/OT) (9/23)
• Physician-Administered Drugs (4/23)
• Prenatal Plus Program (9/20)
• Qualified Residential Treatment Program (QRTP) (4/23)
• Residential Child Care Facility (RCCF) (7/22)
• School Health Services (SHS) (8/22)
• Screening, Brief Intervention, and Referral to Treatment (SBIRT) (3/23)
• Speech Therapy (9/23)
• Targeted Case Management - Transition Coordination (02/22)
• Telemedicine (7/23)
• Transportation
  • EMT (7/21)
  • NEMT (3/23)
• Vision and Eyewear (8/21)

Dental

DentaQuest Colorado Medicaid and CHP+ Dental Program Providers (10/22)
(The above link will redirect to the DentaQuest Colorado Providers page.)

HCBS

• HCBS - Adult - BI, CMHS, and EBD (4/23)
• HCBS - Complementary and Integrative Health (CIH) (9/23)
• HCBS - Children's - CHCBS and CLLI (4/23)
• HCBS - Children's Habilitation Residential Program (CHRP) Waiver Program (7/23)
• HCBS for Persons with Intellectual and/or Developmental Disabilities Waiver Programs (7/23)

Pharmacy

• Pharmacy Billing Manual (9/23)
• Pharmacist Services Billing Manual (9/23)
• 340B Policy Manual (6/23)

UB-04 (Institutional)

• Dialysis Billing Manual (9/23)
• Federally Qualified Health Center/Rural Health Center (FQHC/RHC) (8/22)
• Home Health Billing Manual (10/22)
• Hospice Billing Manual (9/23)
• Indian Health Services (IHS) (3/23)
• Inpatient/Outpatient (IP/OP) Billing Manual (9/23)
• Nursing Facility Billing Manual (4/23)
• Private Duty Nursing Billing Manual (7/22)
• Psychiatric Residential Treatment Facilities (PRTF) Billing Manual (4/23)