Co-Pay Information for Providers

Members Exempt from Co-pay Services Exempt from Co-pay
  • Children ages 18 and under
  • Pregnant women (includes pregnancy, labor, birth and up to 12 months after delivery)
  • Members who choose Denver Health as their health plan
  • Members who live in a nursing home
  • Members who get hospice care
  • American Indian or Alaska Native members
  • Members who are enrolled in Former Foster Care through the end of the month of their 26th birthday
  • Members who are enrolled in the Breast and Cervical Cancer Program
  • Members receiving services under Managed Care programs
  • Emergency services
  • Family planning services and supplies
  • Behavioral health services
  • Preventive services, such as yearly checkups, and vaccines
Please refer to the General Provider Information Manual for additional information.

Co-Pay Amounts

Service type Co-pay
Inpatient hospital services $10 per day, never more than half of the cost Health First Colorado pays for the first day of care in the hospital
Outpatient surgery at an Ambulatory Surgery Center $0 each visit
Outpatient hospital non-emergent emergency room visit $8 each visit
Outpatient Hospital Services $4 each visit
Optometrist Visit $2 each visit
Podiatrist Visit $2 each visit
Primary Care Physician and specialist services $2 each visit
Rural Health Clinic Visit $2 each visit
Federally Qualified Healthcare Center (FQHC) Visit $2 each visit
DME/Disposable Supply Services $1 each day of service
Laboratory services $1 each day of service

Radiology services

*Dental X-rays do not have co-pay

$1 each day of service
Prescription drugs or services (each prescription or refill) $3 generic, $3 name-brand, same co-pay for a 3-month supply by mail

Co-pay Facts

  • Auto-deducted during claims processing
    • Do not deduct from charges billed on claim
  • A provider may not deny services to an individual when such members are unable to immediately pay the co-pay amount. However, the member remains liable for the co-pay at a later date. (8.754.6.B rule in 10 CCR 2505 volume 8.700)
  • Youth from birth to 18 years old are considered children
  • Modifier 33 will bypass co-pay requirements for preventative services. For more detailed information refer to the General Billing Information Manual web page.
  • Examples of other services that do not require co-pay:
    • Dental
    • Home Health
    • HCBS waiver services
    • Transportation
    • Private Duty Nursing
    • Hospice
    • Pediatric Personal Care
  • Do not collect a co-pay from members who have already reached their monthly co-pay limit. If a co-pay is collected on the date of service, but the member has met their monthly co-pay limit when the claim is submitted, the co-pay should be refunded to the member. If a member cannot be reached by mail, a credit may be kept on file for the member's future use. More information on member co-pays is found on the Health First Colorado Co-Pay page.

Where to Find Co-Pay Amounts on the RA

where to find copay information on RA