| Members Exempt from Co-Pay | Services Exempt from Co-Pay |
|---|---|
|
|
| Refer to the General Provider Information Manual for additional information. | |
Co-Pay Amounts
| Service Type | Co-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 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
