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

• Durable Medical Equipment (DME) and Oxygen Supplies During the COVID-19 State of Emergency- 4/8/2020