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Co-Pay Information for Providers

Members Exempt from Co-PayServices 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
Refer to the General Provider Information Manual for additional information.

Co-Pay Amounts

Service TypeCo-Pay
Inpatient hospital services$0 per admission (effective 7/1/2023)
Outpatient surgery at an Ambulatory Surgery Center$0 each visit
Outpatient hospital non-emergent emergency room visit$8 each visit
Outpatient Hospital Services$0 each visit (effective 7/1/2023)
Optometrist Visit$0 each visit (effective 7/1/2023)
Podiatrist Visit$0 each visit (effective 7/1/2023)
Primary Care Physician and specialist services$0 each visit (effective 7/1/2023)
Rural Health Clinic Visit$0 each visit (effective 7/1/2023)
Federally Qualified Healthcare Center (FQHC) Visit$0 each visit (effective 7/1/2023)
DME/Disposable Supply Services$0 each day of service (effective 7/1/2023)
Laboratory services$0 each day of service (effective 7/1/2023)

Radiology services

*Dental X-rays do not have co-pay

$0 each day of service (effective 7/1/2023)
Prescription drugs or services (each prescription or refill)$0 generic, $0 name-brand, same co-pay for a three (3)-month supply by mail (effective 7/1/2023)

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. Refer to the General Provider Information Manual for more detailed information.
  • 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. Visit the Health First Colorado Co-Pay web page for more information on member co-pays.

Where to Find Co-Pay Amounts on the RA

where to find copay information on RA