Fee For Service Rate Information

Information about any and all rate changes impacting State Plan, Home and Community Based Services (HCBS), and all other Fee for Service rates are detailed by service in the following sections. For questions about rates or fee schedules, please contact Victoria Martinez

Annual Rate Updates Information and Resources

Fiscal Year 2021-2022 Provider Rate Adjustments

Health First Colorado (Colorado's Medicaid Program) across-the-board provider rate increases were approved during the 2021-2022 legislative session and are effective for dates of service beginning July 1, 2021. All rate adjustments are subject to CMS (Centers for Medicare and Medicaid Services) approval prior to implementation. The fee schedules located on the Provider Rates and Fee Schedule web page have been updated to reflect the approved 2.5% across-the-board (ATB) rate increases. Rates will be updated in the Colorado interChange once approval is received from CMS.

Services and Supplies Approved for Across-the-Board Decreases:

  • Physician and clinic services
  • Dental Services
  • Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) services
  • Family planning services
  • Inpatient hospital services
  • Outpatient hospital services
  • Laboratory and x-ray services
  • Durable medical equipment, supplies, and prosthetics
  • Non-physician practitioner services
  • Tobacco cessation counseling for pregnant women
  • Ambulatory surgery center services
  • Dialysis center services
  • Physical, occupational, and speech therapy, and audiology services
  • Screening, brief intervention, and referral to treatment (SBIRT) services
  • Rehabilitation/behavioral health services
  • Outpatient substance abuse services
  • Case management services for substance abuse treatment
  • Vision services
  • Extended services for pregnant women
  • Home and community-based services (HCBS)
  • Private duty nursing
  • Acute and long term home health
  • IDD targeted case management
  • Anesthesia services
  • Laboratory and pathology services
  • Targeted Case Management-Transition Service

The 2.5% across the board increase for Home and Community-Based Services (HCBS) waivers services does not require CMS approval. Claims with dates of service on or after July 1, 2021, will be reimbursed at an increased rate for providers for the following waivers:

  • HCBS waivers
    • HCBS - Brain Injury (BI)
    • HCBS - Children's Extensive Supports (CES)
    • HCBS - Children's Home and Community Based Service (CHCBS)
    • HCBS - Children with Life Limiting Illness (CLLI)
    • HCBS - Children's Residential Habilitation Program (CHRP)
    • HCBS - Community Mental Health Supports (CMHS)
    • HCBS - Developmental Disability (DD)
    • HCBS - Elderly, Blind and Disabled (EBD)
    • HCBS - Spinal Cord Injury (SCI)
    • HCBS - Supported Living Services (SLS)

The Department will continue to publish updates when CMS approval is received. Contact Victoria Martinez at Victoria.L.Martinez@state.co.us with questions or concerns.

HCPCS Rate Updates Information and Resources

Procedure codes for health care services are updated annually in January to add new codes, remove obsolete codes, update existing codes and replace codes that have changed. Coding Procedure Terminology (CPT) is determined and published by the American Medical Association (AMA), and HCPCS (Healthcare Common Procedure Coding System) is determined and published by Centers for Medicare and Medicaid Services (CMS). The list of code changes is released in the 4th quarter of each year. See the documents below detailing the Rate Methodology for setting rates for new codes, the fee schedule, crosswalk, code list file, and rate methodology inputs by code for each fiscal year below:

January 1, 2021, HCPCS Updates

January 1, 2020, HCPCS Updates

January 1, 2019, HCPCS Updates

January 1, 2018, HCPCS Updates