Billing Manuals

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

General Provider Information

• General Provider Information Manual (6/24)

Electronic Visit Verification Manual

• Electronic Visit Verification Manual (1/25)

Managed Care Encounters Reporting Guide

• Managed Care Encounters Reporting Guide (3/23)

Appendices

• Appendix A - Colorado Department of Health Care Policy & Financing (3/25)
• Appendix B - Colorado Medical Assistance Program Fiscal Agent (1/25)
• Appendix C - Prior Authorization and Review Agencies (2/25)
• Appendix D - Programs/Services and Authorizing Agencies (3/25)
• Appendix E - County Departments of Human and Social Services (2/24)
• 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) Refer to the Health First Colorado Fee Schedule to see if a PAR is required for the procedure code.
• Appendix O - EAPG Inpatient Only List (2/25)
• Appendix P - Pharmacy Benefit Prior Authorization Procedures and Criteria (1/24)
• Appendix Q - Revenue Code Table (7/21)
• Appendix R - Remittance Advice (RA) Messages (5/25)
• Appendix S - Remittance Advice (RA) Expenditure Reason Codes (1/25)
• Appendix V - Terms, Acronyms and Abbreviations (6/18)
• Appendix X - HCPCS/NDC Crosswalk for Billing Physician-Administered Drugs (5/25)
• Appendix Y - Physician-Administered Drug Medical Benefit Prior Authorization Procedures and Criteria (1/24) (Located under Fee for Service Physician Administered Drugs dropdown menu)
• Appendix Z - Hospital Specialty Drugs (10/24)

Dental

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

HCBS

• HCBS - Adult - Brain Injury (BI), Community Mental Health Supports (CMHS) and Elderly, Blind and Disabled (EBD) (4/25)
• HCBS - Complementary and Integrative Health (CIH) (4/25)
• HCBS - Children's Home and Community Based Services (CHCBS) and Children with Life Limiting Illness (CLLI) (4/25)
• HCBS - Children's Habilitation Residential Program (CHRP) Waiver Program (4/25)
• HCBS - Persons with Intellectual and/or Developmental Disabilities Waiver Programs & Targeted Case Management for Home and Community-Based Services Waiver Programs (4/25)
• Denver Minimum Wage Appendix (12/24)

Institutional (UB-04)

• Dialysis (1/24)
• Emergency Medicaid Services (7/24)
• Federally Qualified Health Center and Rural Health Clinic (4/25)
• Home Health (7/24)
• Hospice (10/24)
• Indian Health Services (1/25)
• Inpatient/Outpatient (IP/OP) (5/25)
• Nursing Facility (4/23)
• Private Duty Nursing (7/24)
• Psychiatric Residential Treatment Facilities (04/25)

Pharmacy

• Pharmacy (5/25)
• Pharmacist Services (4/25)
• 340B Policy and Procedures (5/25)

Professional (CMS 1500)

• Ambulatory Surgery Centers (ASC) (3/25)
• Audiology (7/24)
• Behavioral Health Secure Transportation (BHST) (2/25)
• Doula (1/25)
• Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) (4/25)
  • DMEPOS HCPCS Codes (5/25)
  • Wheelchair Benefit Coverage Policy (4/23)
• Early Intervention (02/25)
• Emergency Medicaid Services (7/24)
• Family Planning Benefit Expansion for Special Populations (8/23)
• Gender-Affirming Care (6/24)
• Immunization (4/25)
• Laboratory Services (1/25)
• Lactation Support Services (4/25)
• Managed Care Programs (10/22)
• Medical-Surgical (11/24)
• Nurse Home Visitor Program (9/20)
• Obstetrical Care (02/25)
• Outpatient Imaging and Radiology (9/24)
• Program of All-Inclusive Care for the Elderly (PACE) (4/21)
• Pediatric Behavioral Therapies (12/24)
• Pediatric Personal Care Benefit (9/23)
• Pharmacist Services (4/25)
• Physical and Occupational Therapy (1/25)
• Physician-Administered Drugs (PAD) (3/24)
• Prenatal Plus Program Outpatient - Fee-For-Service (02/25)
• Qualified Residential Treatment Program (3/25)
• Residential Child Care Facility (RCCF) Program (7/22)
• School Health Services (7/24)
• Screening, Brief Intervention and Referral to Treatment (SBIRT) Program (5/25)
• Speech Therapy (1/25)
• Targeted Case Management - Transition Coordination (2/22)
• Telemedicine (5/25)
• Transportation
  • Behavioral Health Secure Transportation (2/25)
  • Emergency Medical Transportation (EMT) (7/21)
  • Non-Emergent Medical Transportation (NEMT) (5/25)
• Vision Care and Eyewear (4/25)

State Behavioral Health Services

• (Capitated Behavioral Health Benefit) State Behavioral Health Services Billing Manual (updated quarterly)
• Fee-for-Service Behavioral Health Benefit Billing Manual (7/24)