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

Managed Care Encounters Reporting Guide

• Managed Care Encounters Reporting Guide (3/23)

Appendices

• Appendix A - Colorado Department of Health Care Policy & Financing (8/23)
• 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 (2/24)
• 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• Appendix N - No longer active
• Appendix O - EAPG Inpatient Only List (1/23)
• Appendix P - Pharmacy Benefit Prior Authorization Procedures and Criteria (1/24)
• Appendix Q - Revenue Code Table (7/21)
• Appendix R - Remittance Advice (RA) Messages (10/24)
• Appendix S - Remittance Advice (RA) Expenditure Reason Codes (5/24)
• Appendix U - Forms - No longer active. Visit the Provider Forms web page.
• Appendix V - Terms, Acronyms and Abbreviations (6/18)
• Appendix W - No longer active.
• Appendix X - HCPCS/NDC Crosswalk for Billing Physician-Administered Drugs (12/24)
• 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)

CMS 1500 (Professional)

• Ambulatory Surgery Centers (ASC) (5/23)
• Audiology (7/24)
• Behavioral Health Secure Transportation (BHST) (9/24)
• Doula (08/24)
• Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) (12/24)
  • DMEPOS HCPCS Codes
  • Wheelchair Benefit Coverage Policy
• Early Intervention (12/22)
• Emergency Medicaid Services (7/24)
• Family Planning Benefit Expansion for Special Populations (8/23)
• Gender-Affirming Care (6/24)
• Immunization (9/24)
• Laboratory Services (8/24)
• Lactation Support Services (11/24)
• Managed Care Programs (10/22)
• Medical-Surgical (11/24)
• Nurse Home Visitor Program (9/20)
• Obstetrical Care (9/24)
• 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 (10/24)
• Physical and Occupational Therapy (8/24)
• Physician-Administered Drugs (PAD) (3/24)
• Prenatal Plus Program Outpatient - Fee-For-Service (5/23)
• Qualified Residential Treatment Program (12/23)
• Residential Child Care Facility (RCCF) Program (7/22)
• School Health Services (7/24)
• Screening, Brief Intervention and Referral to Treatment (SBIRT) Program (10/24)
• Speech Therapy (7/24)
• Targeted Case Management - Transition Coordination (02/22)
• Telemedicine (10/24)
• Transportation
  • Behavioral Health Secure Transportation (9/24)
  • Emergency Medical Transportation (EMT) (7/21)
  • Non-Emergent Medical Transportation (NEMT) (9/24)
• Vision Care and Eyewear (11/24)

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) (7/24)
• HCBS - Complementary and Integrative Health (CIH) (7/24)
• HCBS - Children's Home and Community Based Services (CHCBS) and Children with Life Limiting Illness (CLLI) (7/24)
• HCBS - Children's Habilitation Residential Program (CHRP) Waiver Program (7/24)
• HCBS - Persons with Intellectual and/or Developmental Disabilities Waiver Programs & Targeted Case Management for Home and Community-Based Services Waiver Programs (7/24)

Pharmacy

• Pharmacy (10/24)
• Pharmacist Services (10/24)
• 340B Policy and Procedures (05/24)

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)

UB-04 (Institutional)

• Dialysis (1/24)
• Emergency Medicaid Services (7/24)
• Federally Qualified Health Center and Rural Health Clinic (11/24)
• Home Health (7/24)
• Hospice (7/24)
• Indian Health Services (12/24)
• Inpatient/Outpatient (IP/OP) (11/24)
• Nursing Facility (4/23)
• Private Duty Nursing (7/24)
• Psychiatric Residential Treatment Facilities (12/23)