Durable Medical Equipment (DME) and Oxygen Supplies

Effective April 3, 2020, throughout the duration of the COVID-19 state of emergency in Colorado, Health First Colorado is waiving prior authorization requirements for oxygen therapy, positive airway pressure devices, respiratory assist devices, ventilators, suction devices, nebulizers and oxygen-related supplies that are emergently provided for COVID-19 treatment. This applies to any diagnosed person with COVID-19 or suspected person under investigation for COVID-19.

For these services to be reimbursed without Prior Authorization, providers must include the 'CR' modifier to designate that the requested item or service is related to treating a member who is diagnosed/suspected with COVID-19.

To support this policy, the Colorado interChange system will be configured to bypass prior authorization edits for DME codes outlined below when the claim type is Professional (M) or Professional Medicare Crossover (B), the billing provider contract is Supply, and modifier CR is submitted on the claim. HCPCS allowed under this policy are shown in the tables below. Note: some codes listed do not require Prior Authorization.

Contact the Provider Call Center for more information.

Billing Guidance

DME CategoryAssociated HCPCS
Positive Airway Pressure Device HumidifiersA7046E0562E0561       
Oxygen Delivery System HumidifiersE1405E1406        
IPPB Device HumidifiersE0500E0550E0555E0560      
Oxygen Storage ContentsE0441E0442E0443E0444S8120S8121    
Oxygen Storage SystemsE0424E0425E0430E0431E0433E0434E0434E0439E0440K0738
Oxygen ConcentratorsE1390E1391E1392       
Respiratory Assist Devices and Related SuppliesE0470E0471E0472       
Ventilators and Related SuppliesE0457E0459E0465E0466A4483S8186A4611A4612A4613S8210
Cough Stimulating Devices/Mucus Removal and Related SuppliesA7020A7025E0482E0483E0606S8185E0480A7026  
Positive Airway Pressure Devices and Related SuppliesA4604A7027A7028A7029A7030A7031A7033A7032A7034A7035
Suction DevicesA7000A7001A7002E0600      
Nebulizers and Related SuppliesA7003A7004A7005A7006A7007A7008A7009A7010A7012A7013
Tracheostomy SuppliesE0755S8189A4608A4618A4623A4624A4625A4629A7501A7502
Generally Related SuppliesA9280A4606S8301A4615A4616A4619A4620A4627A4628E0455