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Home and Community-Based Services for Persons with Intellectual and/or Developmental Disabilities Waiver Programs & Targeted Case Management for Home and Community-Based Services Waiver Programs

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Program Overview: Home and Community-Based Services (HCBS)

The Home and Community-Based Services (HCBS) waiver programs provide Health First Colorado (Colorado's Medicaid program) members who meet special eligibility criteria access to additional services in their homes and communities as an alternative to institutional care. The Home and Community-Based Services programs for persons with intellectual and/or developmental disabilities include:

  • Home and Community-Based Services for Persons with Intellectual and/or Developmental Disabilities Waiver (HCBS-DD)
  • HCBS-Supported Living Services (HCBS-SLS)
  • HCBS-Children's Extensive Support (HCBS-CES)

Level of care determinations are made annually by Contracted Case Management Agencies. Members must meet financial and medical eligibility, as well as program-specific criteria to access services under a waiver. The applicant must be at risk of transition to a nursing facility, hospital, or Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID). To access waiver benefits, members must be willing to receive services in their homes or communities. A member who receives services through a waiver is also eligible for all basic Health First Colorado covered services except nursing facility, ICF/IID, and long-term hospital care. When a member chooses to receive services under a waiver, the services must be provided by certified Health First Colorado providers.

Applicants may apply for more than one waiver but may only receive services through one waiver at a time.

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Persons with Intellectual and/or Developmental Disabilities Waiver (HCBS-DD)

The HCBS-DD Waiver provides persons with intellectual and/or developmental disabilities access to services and supports 24 hours a day to allow them to a live safely and participate in their community. Services include:

  • Residential Habilitation
  • Day Habilitation Services and Supports
    • Specialized Habilitation
    • Supported Community Connections
  • Prevocational Services
  • Supported Employment Services
  • Benefits Planning
  • Non-Medical Transportation Services
  • Behavioral Services (for individuals 21 years of age and older)
  • Specialized Medical Equipment and Supplies
  • Dental Services (for individuals 21 years of age and older)
  • Vision Services (for individuals 21 years of age and older)

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Supported Living Services (SLS)

The HCBS-SLS Waiver provides services and supports to assist persons with intellectual and/or developmental disabilities to live in the person's own home, apartment, family home, or rental unit that qualifies as an SLS setting. Services include:

  • Personal Care
  • Respite
  • Homemaker
    • Basic
    • Enhanced
  • Consumer Directed Attendant Support Services (CDASS)
  • Mentorship
  • Day Habilitation Services
    • Specialized Habilitation
    • Supported Community Connections
    • Prevocational Services
  • Supported Employment Services
  • Non-Medical Transportation
  • Behavioral Services (for individuals 21 years of age and older)
  • Professional Services
    • Hippotherapy
    • Movement Therapy
    • Massage Therapy
  • Personal Emergency Response System (PERS)
  • Home Accessibility Adaptations
  • Vehicle Modifications
  • Assistive Technology
  • Dental Services (for individuals 21 years of age and older)
  • Vision Services (for individuals 21 years of age and older)
  • Specialized Medical Equipment and Supplies
  • Home Delivered Meals
  • Life Skills Training
  • Peer Mentorship
  • Transition Setup
  • Remote Supports
  • Benefits Planning

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Children's Extensive Support (CES)

The HCBS-CES Waiver is for children ages birth to 18 with intellectual and/or developmental disabilities or for children ages four (4) and under who are at risk of a developmental delay. Services include:

  • Respite
  • Youth Day Services
  • Homemaker
    • Basic
    • Enhanced
  • Community Connector
  • Professional Services
    • Movement Therapy
    • Massage Therapy
  • Specialized Medical Equipment and Supplies
  • Adapted Therapeutic Recreational Equipment and Fees
  • Home Accessibility Adaptations
  • Vehicle Modifications
  • Assistive Technology
  • Caregiver Education

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Program Overview: Targeted Case Management (TCM)

Targeted Case Management (TCM) is an optional Health First Colorado benefit for members who have been determined by a Contracted Case Management Agency to meet eligibility criteria and are actively enrolled in one of the programs listed below. Member eligibility for this benefit is dependent on whether the member is receiving case management from one of the Department of Health Care Policy & Financing's (the Department) Contracted Case Management Agencies.

Members, by Waiver, eligible for TCM when billed by a Contracted Case Management Agency:

  • Brain Injury Waiver (HCBS-BI)
  • Children's Extensive Support (HCBS-CES) Waiver
  • Children’s Home and Community-Based Services (HCBS-CHCBS) Waiver
  • Children with Life Limiting Illness (HCBS-CLLI) Waiver
  • Children's Residential Habilitation Program (HCBS-CHRP) Waiver
  • Community Mental Health Supports Waiver (HCBS-CMHS)
  • Complementary and Integrative Health Waiver (HCBS-CIH)
  • Persons with Intellectual and/or Developmental Disabilities (HCBS-DD) Waiver
  • Elderly, Blind, and Disabled Waiver (HCBS-EBD)
  • Supported Living Services (HCBS-SLS) Waiver

TCM - Per Member/Per Month (PM/PM) services

A component of TCM is paid on a PM/PM basis and requires that Contracted Case Management Agencies must document the provision of a billable activity in the Care and Case Management (CCM) System within ten (10) business days of the provision of that service, ensuring the date of contact is entered correctly. Billable activities include, but are not limited to, the following:

  • Development and implementation of a Person-Centered Support Plan,
  • Prior Authorization of services identified through assessment and service planning process,
  • Development and revision as needed of a Person-Centered Service Plan,
  • Referral and related activities to help a member obtain needed services.
  • Monitoring and monitoring follow-up activities that are necessary to ensure the Person-Centered Service Plan is implemented and adequately addresses the member's needs.
  • Exclusions for TCM include administrative tasks such as mass physical or electronic mailings, as well as automated telephone calls.
  • Billing for TCM activities that are paid for by contractual payments are considered duplicative and should be excluded.
  • Activities that are not documented within the required timeframes above should not be billed as TCM.

TCM - Monitoring Visits

A separate component of TCM encompasses face-to-face and remote monitoring the quality of services to ensure the member is receiving services in accordance with the service plan, ensure member satisfaction with services, and to ensure the health, safety, and welfare of the member. Rural travel add-ons may only be billed with one of the required, quarterly face-to-face visits if performed in person. Rural travel add-ons may be billed for members residing in counties designated as rural or frontier. Rural add-on may not be billed in conjunction with telephone/virtual monitoring.  This work includes monitoring the effective and efficient provision of services across multiple funding sources.

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Prior Authorization Requests (PARs)

Unless otherwise noted, all HCBS services require prior approval before they can be reimbursed by Health First Colorado. Contracted Case Management Agencies complete the Prior Approval and/or Over Daily PAR requests for their specific programs according to instructions published in regulations. Refer to Appendix A located on the Billing Manuals web page under the Appendices drop-down for the telephone numbers for the aforementioned departments.

Contracted Case Management Agencies transmit electronic HCBS PAR information to the Medicaid Management Information System (interChange) for the HCBS Waivers- through the Bridge subsystem of the interChange.

The CMAs’ responsibilities include, but are not limited to:

  • Informing members and/or legal guardian of the functional and target waiver eligibility process.
  • Submitting a copy of the approved Level of Care Certification to the County department of human/social services for a Health First Colorado member identification number.
  • Developing the appropriate Prior Approval and/or Service Accommodation Request for approval.
  • Submitting a copy of the Prior Authorization and/or Cost Containment document to the authorizing agent. Refer to Appendix D located on the Billing Manuals web page under the Appendices drop-down for a list of authorizing agents. 
  • Assessing the member's health and social needs.
  • Arranging for face-to-face contact with the member within the following timeframes:     
    • Two (2) days for a referral from a hospital
    • Five (5) days for a nursing facility
    • 10 days for all other referrals for long-term services and supports
  • Monitoring and evaluating services.
  • Reassessing each member.
  • Demonstrating continued cost-effectiveness whenever services increase or decrease.

Approval of prior authorization does not guarantee Health First Colorado payment and does not serve as a timely filing waiver. Prior authorization only assures that the approved service is determined to be necessary and is considered a benefit of the Health First Colorado. All claims, including those for prior authorized services, must meet eligibility and claim submission requirements (e.g., timely filing, provider information completed appropriately, required attachments included, etc.) before payment can be made.

Prior approvals must be completed thoroughly and accurately. If an error is noted on an approved request, it should be brought to the attention of the member's case manager for corrections. Procedure codes, quantities, etc., may be changed or entered by the member's case manager at any time during the individual's plan year.

The authorizing agent or Contracted Case Management Agency is responsible for timely submission and distribution of copies of approvals to agencies and providers contracted to provide services.

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PAR Submission

All PARs are submitted via the Bridge, which directly interfaces with the Colorado interChange Medicaid Management Information System. Access to the Bridge is afforded to case managers only and is accomplished via the Medicaid Enterprise User Provisioning System (MEUPS).

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Consumer Directed Attendant Support Services (CDASS)

For members authorized to receive CDASS, case managers will need to enter the data into one of the web-based systems in addition to sending a PAR to the Department's fiscal agent. Members have the option to receive Financial Management Services (FMS) from one (1) of two (2) FMS vendors:

  • Palco
  • Public Partnerships, LLC (PPL)

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Claim Submission

Submission of claims for services rendered must not be duplicative. Providers cannot be reimbursed for delivering the same service to the same member on the same day at the same time, whether such services are billed on the same claim or on multiple/different claims. Additionally, providers are barred from billing services that share or have overlapping service definitions but are described by different procedure codes on the same day to the same member. Collectively referred to as duplicate claims, reimbursement for such claims requires clear documentation of the necessity of the service and that there was not duplicative service delivery. 

Refer to the service definitions on the Colorado Code of Regulations website to identify if claims are duplicative based on services rendered. Refer to the provider specialty code enrollment requirements on the HCBS Provider Specialty Code List web page to identify services that may be provided by an individual provider. Providers may only bill for services approved in the members’ service plans.

In any instance in which duplicate claim submission results in Medicaid reimbursement, the Department has the authority to recoup funds from providers.

Refer to the General Provider Information Manual located on the Billing Manuals web page under the General Provider Information drop-down for general billing information, including claims submission.

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HCBS-DD Procedure Code Table

Providers may bill the following procedure codes for HCBS-DD services:

Persons with Intellectual and/or Developmental Disabilities (HCBS-DD)
DescriptionProcedure CodeModifier(s)LevelUnit Designation
Specialty 673: Residential Habilitation Group Home
Group Residential Services and Supports (GRSS)T2016
T2016
T2016
T2016
T2016
T2016
T2016
T2016
U3, HQ
U3, 22, HQ
U3, TF, HQ
U3, TF, 22, HQ
U3, TG, HQ
U3, TG, 22, HQ
U3, SC, HQ
U3, SC, HQ HI
U3, SC, HQ HB
Level 1
Level 2
Level 3
Level 4
Level 5
Level 6
Level 7
GJRC Only
PRC Only
Day
Day
Day
Day
Day
Day
Day
Day
Day
Specialty 674: Residential Habilitation IRSS/Host Home
Individual Residential Services and Supports (IRSS)T2016
T2016
T2016
T2016
T2016
T2016
T2016
U3
U3, 22
U3, TF
U3, TF, 22
U3, TG
U3, TG, 22
U3, SC
Level 1
Level 2
Level 3
Level 4
Level 5
Level 6
Level 7
Day
Day
Day
Day
Day
Day
Day
Individual Residential Services and Supports/Host Home (IRSS/HH)T2016
T2016
T2016
T2016
T2016
T2016
T2016
U3, TT
U3, 22, TT
U3, TF, TT
U3, TF, 22, TT
U3, TG, TT
U3, TG, 22, TT
U3, SC, TT
Level 1
Level 2
Level 3
Level 4
Level 5
Level 6
Level 7
Day
Day
Day
Day
Day
Day
Day
Specialty 639: Day Habilitation Services - Specialized Habilitation
Specialized Habilitation - Tier 2 (Traditional/Current)T2021
T2021
T2021
T2021
T2021
T2021
T2021
T2021
T2021
U3, HQ
U3, 22, HQ
U3, TF, HQ
U3, TF, 22, HQ
U3, TG, HQ
U3, TG, 22, HQ
U3, SC, HQ
U3, SC, HQ, HI
U3, SC, HQ, HB
Level 1
Level 2
Level 3
Level 4
Level 5
Level 6
Level 7
GJRC Only
PRC Only
15 Minutes
15 Minutes
15 Minutes
15 Minutes
15 Minutes
15 Minutes
15 Minutes
15 Minutes
15 Minutes
Specialty 713: Day Habilitation - Supported Community Connections
Supported Community Connections - Tier 2 (Traditional/Current)T2021
T2021
T2021
T2021
T2021
T2021
T2021
T2021
T2021
U3
U3, 22
U3, TF
U3, TF, 22
U3, TG
U3, TG, 22
U3, SC
U3, SC, HI
U3, SC, HB
Level 1
Level 2
Level 3
Level 4
Level 5
Level 6
Level 7
GJRC Only
PRC Only
15 Minutes
15 Minutes
15 Minutes
15 Minutes
15 Minutes
15 Minutes
15 Minutes
15 Minutes
15 Minutes
Supported Community Connections - Tier 3 (Individual)S5100U3, HBAll Levels15 Minutes
Specialty 679: Supported Employment
*Job Development and Job Placement are available as waiver services only when those services are first denied by the Division of Vocational Rehabilitation (DVR) or those DVR services are not available to the member due to an order of selection (DVR waiting list).
Job Coaching
(Group)
T2019
T2019
T2019
T2019
T2019
T2019
U3, HQ
U3, 22, HQ
U3, TF, HQ
U3, TF, 22, HQ
U3, TG, HQ
U3, TG, 22, HQ
Level 1
Level 2
Level 3
Level 4
Level 5
Level 6
15 Minutes
15 Minutes
15 Minutes
15 Minutes
15 Minutes
15 Minutes
Job Coaching
(Individual)
T2019U3, SCAll Levels15 Minutes
Job Development (Group) - Outside Denver CountyH2023U3, HQ  
Job Development (Group) - Denver CountyH2023U3, HQ, HX  
Job Development (Individual) - Outside Denver CountyH2023
H2023
H2023
U3
U3, 22
U3, TF
Level 1-2
Level 3-4
Level 5-6
15 Minutes
15 Minutes
15 Minutes
Job Development (Individual) - Denver CountyH2023
H2023
H2023
U3, HX
U3, 22, HX
U3, TF, HX
Level 1-2
Level 3-4
Level 5-6
15 Minutes
15 Minutes
15 Minutes
Job Placement
(Group)
H2024U3, HQAll LevelsDollar
Job Placement
(Individual)
H2024U3All LevelsDollar
Workplace AssistanceT2019U3, HBAll Levels15 Minutes
Specialty 669: Prevocational Services
Pre-Vocational ServicesT2015
T2015
T2015
T2015
T2015
T2015
U3, HQ
U3, 22, HQ
U3, TF, HQ
U3, TF, 22, HQ
U3, TG, HQ
U3, TG, 22, HQ
Level 1
Level 2
Level 3
Level 4
Level 5
Level 6
15 Minutes
15 Minutes
15 Minutes
15 Minutes
15 Minutes
15 Minutes
Specialty 661: Non-Medical Transportation (NMT)
Other (Public Conveyance)T2004U3SingleDollar
Mileage Range 1, Outside Denver County
Mileage Range 2, Outside Denver County
Mileage Range 3, Outside Denver County
T2003
T2003
T2003
U3
U3, 22
U3, TF
0-10 miles
11-20miles
20 miles
Trip
Trip
Trip
Mileage Range 1, Denver County
Mileage Range 2, Denver County
Mileage Range 3, Denver County
T2003
T2003
T2003
U8, HX
U8, 22, HX
U8, TF, HX
0-10 miles
11-20miles
20 miles
Trip
Trip
Trip
Specialty 610: Behavioral Services
*Behavioral Services for individuals aged 18-20 on the DD waiver must be accessed through state plan benefits or EPSDT.
Behavioral Line StaffH2019U3Single15 Minutes
Behavioral ConsultationH2019U3, 22, TGAll Levels15 Minutes
Behavioral Counseling (Individual)H2019U3, TF, TGAll Levels15 Minutes
Behavioral Counseling (Group)H2019U3, TF, HQAll Levels15 Minutes
Behavioral Plan AssessmentT2024U3, 22All Levels15 Minutes
Specialty 667: Specialized Medical Equipment and Supplies
Disposable SuppliesT2028U3All LevelsDollar
EquipmentT2029U3All LevelsDollar
Specialty 749: Dental Services
*Dental Services for individuals aged 18-20 on the DD waiver must be accessed through state plan benefits or EPSDT.
Basic/PreventativeD2999U3All LevelsDollar
MajorD2999U3, 22All LevelsDollar
Specialty 687: Vision
Vision
*Vision services for individuals aged 18-20 on the DD waiver must
be accessed through state plan benefits or EPSDT.
V2799U3All LevelsDollar
Specialty 752: Home Delivered Meals
Home Delivered MealsS5170U3 1 unit = 1 meal
Home Delivered Meals after 1st discharge from a 24hr hospitalizationS5170U3, TFAll levels1 unit = 1 meal
Home Delivered Meals after 2nd discharge from a 24hr hospitalizationS5170U3, TGAll levels1 unit = 1 meal
Specialty 754: Peer Mentorship
Peer MentorshipH2015U3 1 unit = 15 minutes
Specialty 744: Benefits Planning
Benefits PlanningT2019U3, HIAll Levels1 unit = 15 minutes
Specialty 636: Community Transition Services
CoordinatorT2038U3All levels15 minutes
Setup ExpensesA9900U3All levelsOne-time Payment

 

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HCBS-SLS Procedure Code Table

Supported Living Services (SLS)
DescriptionProcedure CodeModifier(s)LevelUnit Designation
Specialty 664: Personal Care
Personal CareT1019U8All Levels15 Minutes
Specialty 676: Respite
Individual – Outside Denver CountyS5150
S5151
U8
U8
All Levels
All Levels
15 Minutes
Day
Individual – Denver CountyS5150
S5151
U8, HX
U8, HX
All Levels
All Levels
15 Minutes
Day
GroupS5151U8, HQAll LevelsDollar
Group Overnight (Camp)T2036U8All LevelsDollar
Specialty 652: Homemaker
Basic – Outside Denver CountyS5130U8All Levels15 Minutes
Basic – Denver CountyS5130U8, HXAll Levels15 Minutes
Enhanced – Outside Denver CountyS5130U8, 22All Levels15 Minutes
Enhanced – Denver CountyS5130U8, 22, HXAll Levels15 Minutes
Specialty 702: Consumer Directed Attendant Support Services (CDASS)
CDASS, Non – Health Maintenance (Cent / Unit)T2025U8All Levels1 unit = $0.01
CDASS, Health Maintenance (Cent / Unit)T2025U8, SEAll Levels1 unit = $0.01
CDASS Per Member / Per MonthT2040U8All Levels1 unit = 1 month
Specialty 659: Mentorship
Mentorship, Denver CountyH2021U8All Levels
All Levels
15 Minutes
15 Minutes
Mentorship, Outside Denver CountyH2021U8, HXAll Levels
All Levels
15 Minutes
15 Minutes
Specialty 639: Day Habilitation - Specialized Habilitation
Specialized Habilitation - Tier 2- (Traditional/Current)T2021
T2021
T2021
T2021
T2021
T2021
U8, HQ
U8, 22, HQ
U8, TF, HQ
U8, TF, 22, HQ
U8, TG, HQ
U8, TG, 22, HQ
Level 1
Level 2
Level 3
Level 4
Level 5
Level 6
15 Minutes
15 Minutes
15 Minutes
15 Minutes
15 Minutes
15 Minutes
Specialty 713: Day Habilitation - Supported Community Connections
Supported Community Connections - Tier 2 (Traditional/Current)T2021
T2021
T2021
T2021
T2021
T2021
U8
U8, 22
U8, TF
U8, TF, 22
U8, TG
U8, TG, 22
Level 1
Level 2
Level 3
Level 4
Level 5
Level 6
15 Minutes
15 Minutes
15 Minutes
15 Minutes
15 Minutes
15 Minutes
Supported Community Connections - Tier 3 (Individual)S5100U8, HBAll Levels15 Minutes
Specialty 669: Prevocational Services
Pre-Vocational ServicesT2015
T2015
T2015
T2015
T2015
T2015
U8, HQ
U8, 22, HQ
U8, TF, HQ
U8, TF, 22, HQ
U8, TG, HQ
U8, TG, 22, HQ
Level 1
Level 2
Level 3
Level 4
Level 5
Level 6
15 Minutes
15 Minutes
15 Minutes
15 Minutes
15 Minutes
15 Minutes
Specialty 679: Supported Employment
*Job Development and Job Placement are available as waiver services only when those services are first denied by the Division of Vocational Rehabilitation (DVR) or those DVR services are not available to the member due to an order of selection (DVR waiting list).
Job Coaching (Group)T2019
T2019
T2019
T2019
T2019
T2019
U8, HQ
U8, 22, HQ
U8, TF, HQ
U8, TF, 22, HQ
U8, TG, HQ
U8, TG, 22, HQ
Level 1
Level 2
Level 3
Level 4
Level 5
Level 6
15 Minutes
15 Minutes
15 Minutes
15 Minutes
15 Minutes
15 Minutes
Job Coaching (Individual)T2019U8, SCAll Levels15 Minutes
SE Job Development- Group – Outside Denver CountyH2023U8, HQAll Levels15 Minutes
SE Job Development- Group – Denver CountyH2023U8, HQ, HXAll Levels15 Minutes
SE Job Development- IndividualH2023
H2023
H2023
U8
U8, 22
U8, TF
Level 1-2
Level 3-4
Level 5-6
15 Minutes
15 Minutes
15 Minutes
SE Job Development – Individual – Denver CountyH2023
H2023
H2023
U8, HX
U8, 22, HX
U8, TF, HX
Level 1-2
Level 3-4
Level 5-6
15 Minutes
15 Minutes
15 Minutes
SE Job Placement- GroupH2024U8, HQAll LevelsDollar
SE Job Placement- IndividualH2024U8All LevelsDollar
Workplace AssistanceT2019U8, HBAll Levels1 unit = 15 minutes
Specialty 661: Non-Medical Transportation (NMT)
Day Program - Mileage Range 1, Outside Denver County
Day Program - Mileage Range 2, Outside Denver County
Day Program - Mileage Range 3, Outside Denver County
T2003
T2003
T2003
U8
U8, 22
U8, TF
0 to 10
11 to 20
21 and Up
Trip
Trip
Trip
Mileage Range 1, Denver County
Mileage Range 2, Denver County
Mileage Range 3, Denver County
T2003
T2003
T2003
U8, HX
U8, 22, HX
U8, TF, HX
0-10 miles
11-20miles
20 miles
Trip
Trip
Trip
Not Day ProgramT2003U8, SCAll DistancesTrip
Other (Public Conveyance)T2004U8All DistancesDollar
Specialty 610: Behavioral Services
*Behavioral Services for individuals aged 18-20 on the SLS waiver must be accessed through state plan benefits or EPSDT.
Behavioral Line StaffH2019U8All Levels15 Minutes
Behavioral ConsultationH2019U8, 22, TGAll Levels15 Minutes
Behavioral Counseling (Individual)H2019U8, TF, TGAll Levels15 Minutes
Behavioral Counseling (Group)H2019U8, TF, HQAll Levels15 Minutes
Behavioral Plan AssessmentT2024U8, 22All Levels15 Minutes
PROFESSIONAL SERVICES
Specialty 729: Professional Services - Massage Therapy
Massage Therapy97124U8All Levels15 Minutes
Specialty 672:  Professional Services - Movement Therapy
Movement Therapy Bachelors
Movement Therapy Masters
G0176
G0176
U8
U8, 22
All Levels15 Minutes
15 Minutes

Specialty 670: Professional Services - Hippotherapy

Services removed from the CHRP waiver effective July 1, 2024.

Refer to the Physical and Occupational Therapy Billing Manual or Speech Therapy Billing Manual for State Plan Hippotherapy.

Specialty 600: Adaptive Therapeutic Recreation Equipment/Fees
Recreational Facility Fees/PassesS5199U8All LevelsDollar
Specialty 677: Specialized Medical Equipment and Supplies (SMES)
Supplies and DisposableT2028U8All LevelsDollar
EquipmentT2029U8All LevelsDollar
Specialty 668: Personal Emergency Response (PERS)
MonitoringS5161U8All LevelsMonth
Install/PurchaseS5160U8All LevelsPurchase
Specialty 756: Remote Supports
Remote Support ServiceO593TU8All Levels15 Minutes
Remote Supports Technology (Install/purchase)A9279U8All LevelsMonthly Purchase
Specialty 648: Home Accessibility Adaptations
Home Accessibility AdaptationsS5165U8All Levels1 unit = half of each modification
Specialty 685: Vehicle Modifications
Vehicle ModificationsT2039U8All LevelsDollar
Specialty 607: Assistive Technology
Assistive TechnologyT2035U8All LevelsDollar
Specialty 749: Dental
*Dental Services for individuals aged 18-20 on the SLS waiver must be accessed through state plan benefits or EPSDT.
Basic / PreventativeD2999U8All LevelsDollar
MajorD2999U8, 22All LevelsDollar
Specialty 687: Vision
Vision Services *Vision Services for individuals aged 18-20 on the SLS waiver must be accessed through state plan benefits or EPSDT.V2799U8All LevelsDollar
Specialty 636: Community Transition Services
CoordinatorT2038U8All Levels15 Minutes
Setup ExpensesA9900U8All LevelsOne-time Payment
Specialty 754: Peer Mentorship
Home Delivered MealsS5170U8All LevelsPer Meal
Home Delivered Meals after 1st discharge from a 24-hr hospitalizationS5170U8, TFAll Levels1 unit = 1 meal
Home Delivered Meals after 2nd discharge from a 24-hr hospitalizationS5170U8, TGAll Levels1 unit = 1 meal
Specialty 752: Home Delivered Meals
Life Skills TrainingH2014U8All Levels15 Minutes
Specialty 753: Life Skills Training
Peer MentorshipH2015U8All Levels15 Minutes
Specialty 744: Benefits Planning
Benefits PlanningT2019U8, HIAll Levels1 unit = 15 minutes

 

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CES Procedure Code Table

Providers may bill the following procedure codes for HCBS-CES services:

Children's Extensive Support (CES)
DescriptionProcedure CodeModifier(s)Unit Designation
Specialty 676: Respite
Individual – Outside Denver CountyS5150
S5151
U7
U7
15 Minutes
Day
Individual – Denver CountyS5150
S5151
U7, HX
U7, HX
15 Minutes
Day
GroupS5151U7, HQDollar
Group Overnight (Camp)T2036U7Dollar
Specialty 751: Youth Day
IndividualT2027U715 Minutes
GroupT2027U7, HQ15 Minutes
Specialty 652: Homemaker
Basic – Outside Denver CountyS5130U715 Minutes
Basic – Denver CountyS5130U7, HX15 Minutes
Enhanced – Outside Denver CountyS5130U7, 2215 Minutes
Enhanced – Denver CountyS5130U7, 22, HX15 Minutes
Homemaker Basic Parental Provision – Outside Denver CountyS5130U7, HA, HI15 Minutes
Homemaker Basic Parental Provision – Denver CountyS5130U7, HA, HI, HX15 Minutes
Homemaker Enhanced Parental Provision – Outside Denver CountyS5130U7, HA15 Minutes
Homemaker Enhanced Parental Provision – Denver CountyS5130U7, HA, HX15 Minutes
Specialty 634: Community Connector
Community Connector – Outside Denver CountyH2021U715 Minutes
Community Connector – Denver CountyH2021U715 Minutes
Community Connector Parental Provision – Outside Denver CountyH2021U7, HA15 Minutes
Community Connector Parental Provision – Denver CountyH2021U7, HA, HX15 Minutes
Specialty 729: Professional Services - Massage Therapy 
Massage Therapy97124U715 Minutes
Specialty 672: Professional Services - Movement Therapy
Movement Therapy Bachelors
Movement Therapy Masters
G0176
G0176
U7
U7, 22
15 Minutes
15 Minutes

Specialty 670: Professional Services - Hippotherapy

Services removed from the CHRP waiver effective July 1, 2024.

Refer to the Physical and Occupational Therapy Billing Manual or Speech Therapy Billing Manual for State Plan Hippotherapy.

Specialty 677: Specialized Medical Equipment and Supplies
Disposable Supplies
Equipment
T2028
T2029
U7
U7
Dollar
Dollar
Specialty 600: Adaptive Therapeutic Recreational Equipment and Fees
Equipment
Recreational Facility Fees/Passes
T1999
S5199
U7
U7
Dollar
Dollar
Specialty 648: Home Accessibility Adaptations
Home Accessibility AdaptationsS5165U71 unit = half of each modification
Specialty 685: Vehicle Modifications
Vehicle ModificationsT2039U7Dollar
Specialty 607: Assistive Technology
Assistive TechnologyT2035U7Dollar
Assistive Technology DeviceT2035

U7

SE

Dollar
Specialty 662: Caregiver Education
Caregiver EducationH1010U7Dollar / $1,000 Max. Year
Specialty 882: CHRP Youth Mentorship-CES/CHRP Therapeutic Respite
Skilled Therapeutic (4 hours or less) - Outside Denver CountyT1005U7, HA15 Minutes
Skilled Therapeutic (4 hours or less) - Denver CountyT1005U7, HA, HX15 Minutes
Skilled Therapeutic (4 hours or more) - Outside Denver CountyS9125U7, HADay
Skilled Therapeutic (4 hours or more) - Denver CountyS9125U7, HA, HXDay
Specialty 615: Skilled Respite
Skilled CNA (4 hours or less) - Outside Denver CountyT1005U715 Minutes
Skilled CNA (4 hours or less) - Denver CountyT1005U7, HX15 Minutes
Skilled RN, LPN (4 hours or less) - Outside Denver CountyT1005U7, TD15 Minutes
Skilled RN, LPN (4 hours or less) - Denver CountyT1005U7, TD, HX15 Minutes
Skilled CNA (4 hours or more) - Outside Denver CountyS9125U7Day
Skilled CNA (4 hours or more) - Denver CountyS9125U7, HXDay
Skilled RN, LPN (4 hours or more) - Outside Denver CountyS9125U7, TDDay
Skilled RN, LPN (4 hours or more) - Denver CountyS9125U7, TD, HXDay

 

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TCM Procedure Code Table

Eligible Case Management Agencies may bill the following procedure codes for TCM services. Note that the maximums per service plan year are cumulative.

DescriptionProcedure CodeModifier(s)Unit Designation
Specialty 11/771: Targeted Case Management (TCM) - BI, CHCBS, CHRP, CES, CHRP, CIH, CLLI, CMHS, DD, EBD, SLS
Targeted Case Management, per member, per monthT2023HI1 Unit, maximum of 12 units per service plan year
Targeted Case Management - Monitoring Visit (in-person)T2024HI1 Unit, Maximum of four (4) units per service plan year
Targeted Case Management – Monitoring Visit (telephone, video, etc.)T2024HI, GT1 Unit, Maximum of four (4) units per service plan year
Targeted Case Management - Monitoring Visit, rural add-on – allowable for agencies designated as rural or frontier by HCPFA0170HI

1 Unit, Maximum of four (4) units per service plan year

*May not be billed with TCM Monitoring Visit (telephone, video, etc.) T2024, HI, GT

 

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HCBS- CES, CHRP, DD and SLS Paper Claim Reference Table

The following paper form reference table describes required fields for the paper CMS 1500 claim form for HCBS-CES, HCBS-CHRP, HCBS-DD and HCBS-SLS claims:

CMS Field Number and LabelField is?Instructions
1. Insurance TypeRequiredPlace an "X" in the box marked as Medicaid.
1a. Insured's ID NumberRequiredEnter the member's Health First Colorado seven-digit ID number as it appears on the Health First Colorado Identification card. Example: A123456.
2. Patient's NameRequiredEnter the member's last name, first name, and middle initial.
3. Patient's Date of Birth/SexRequiredEnter the member's birth date using two digits for the month, two digits for the date, and two digits for the year. Example: 070114 for July 1, 2014.

Place an "X" in the appropriate box to indicate the sex of the member.
4. Insured's NameNot required 
5. Patient's AddressNot Required 
6. Client Relationship to InsuredNot Required 
7. Insured's AddressNot Required 
8. Reserved for NUCC UseNot Required 
9. Other Insured's NameNot Required 
9a. Other Insured's Policy or Group NumberNot Required 
9b. Reserved for NUCC Use  
9c. Reserved for NUCC Use  
9d. Insurance Plan or Program NameNot Required 
10a-c. Is patient's condition related to?Not Required 
10d. Reserved for Local Use  
11. Insured's Policy, Group or FECA NumberNot Required 
11a. Insured's Date of Birth, SexNot Required 
11b. Other Claim IDNot Required 
11c. Insurance Plan Name or Program NameNot Required 
11d. Is there another Health Benefit Plan?Not Required 
12. Patient's or Authorized Person's signatureRequiredEnter "Signature on File", "SOF", or legal signature. If there is no signature on file, leave blank or enter "No Signature on File".

Enter the date the claim form was signed.
13. Insured's or Authorized Person's SignatureNot Required 
14. Date of Current Illness Injury or PregnancyNot Required 
15. Other DateNot Required 
16. Date Patient Unable to Work in Current OccupationNot Required 
17. Name of Referring PhysicianConditional 
18. Hospitalization Dates Related to Current ServiceNot Required 
19. Additional Claim InformationConditional 
20. Outside Lab?
$ Charges
Not Required 
21. Diagnosis or Nature of Illness or InjuryRequiredEnter at least one but no more than twelve diagnosis codes based on the member's diagnosis/condition.

Enter applicable ICD-10 indicator.

HCBS
DD, CES, CHRP, and SLS may use R69.
22. Medicaid Resubmission CodeConditionalList the original reference number for resubmitted claims.

When resubmitting a claim, enter the appropriate bill frequency code in the left- hand side of the field.
7 - Replacement of prior claim
8 - Void/Cancel of prior claim
This field is not intended for use for original claim submissions.
23. Prior AuthorizationNot RequiredHCBS
Leave blank.
24. Claim Line DetailInformationThe paper claim form allows entry of up to six detailed billing lines. Fields 24A through 24J apply to each billed line.

Do not enter more than six lines of information on the paper claim. If more than six lines of information are entered, the additional lines will not be entered for processing.

Each claim form must be fully completed (totaled).

Do not file continuation claims (e.g., Page 1 of 2).
24A. Dates of ServiceRequired

The field accommodates the entry of two dates: a "From" date of services and a "To" date of service. Enter the date of service using two digits for the month, two digits for the date and two digits for the year. Example: 010116 for January 1, 2016.

FromTo
010119   

or

FromTo
010119010119

Span dates of service

FromTo
010119013119

Practitioner claims must be consecutive days.
Single Date of Service: Enter the six-digit date of service in the "From" field. Completion of the "To field is not required. Do not spread the date entry across the two fields.

Span billing: permissible if the same service (same procedure code) is provided on consecutive dates.

24B. Place of ServiceRequired

Enter the Place of Service (POS) code that describes the location where services were rendered. Health First Colorado accepts the CMS place of service codes.

11Office
12Home
24C. EMGNot Required 
24D. Procedures, Services, or SuppliesRequiredEnter the procedure code that specifically describes the service for which payment is requested.

HCBS
Refer to the HCBS-DDHCBS-CESHCBS-SLS or TCM procedure code tables.
24D. ModifierRequiredEnter the appropriate procedure-related modifier that applies to the billed service. Up to four modifiers may be entered when using the paper claim form.
Refer to the HCBS-DD, HCBS-CES, HCBS-CHRP or HCBS-SLS or TCM procedure code tables.
24E. Diagnosis PointerRequiredEnter the diagnosis code reference letter (A-L) that relates the date of service and the procedures performed to the primary diagnosis.

At least one diagnosis code reference letter must be entered.

When multiple services are performed, the primary reference letter for each service should be listed first, other applicable services should follow.

This field allows for the entry of four (4) characters in the unshaded area.
24F. $ ChargesRequiredEnter the usual and customary charge for the service represented by the procedure code on the detail line. Do not use commas when reporting dollar amounts. Enter 00 in the cents area if the amount is a whole number.

Some CPT procedure codes are grouped with other related CPT procedure codes. When more than one procedure from the same group is billed, special multiple pricing rules apply.

The base procedure is the procedure with the highest allowable amount. The base code is used to determine the allowable amounts for additional CPT surgical procedures when more than one procedure from the same grouping is performed.

Submitted charges cannot be more than charges made to non-Health First Colorado-covered individuals for the same service.

Do not deduct Health First Colorado co-pay or commercial insurance payments from the usual and customary charges.
24G. Days or UnitsRequiredEnter the number of services provided for each procedure code.

Enter whole numbers only- do not enter fractions or decimals.
24G. Days or UnitsGeneral InstructionsA unit represents the number of times the described procedure or service was rendered.

Except as instructed in this manual or in Health First Colorado bulletins, the billed unit must correspond to procedure code descriptions. The following examples show the relationship between the procedure description and the entry of units.

Home and Community-Based Services
Combine units of services for a single procedure code for the billed time period on one detail line. Dates of service do not have to be reported separately. Example: If forty units of personal care services were provided on various days throughout the month of January, bill the personal care procedure code with a From Date of 01/03/XX and a To Date of 01/31/XX and 40 units.
24H. EPSDT/Family PlanNot Required 
24I. ID QualifierNot Required 
24J. Rendering Provider ID #RequiredIn the shaded portion of the field, enter the NPI of the Health First Colorado provider number assigned to the individual who actually performed or rendered the billed service. This number cannot be assigned to a group or clinic.
25. Federal Tax ID NumberNot Required 
26. Patient's Account NumberOptionalEnter information that identifies the member or claim in the provider's billing system. Submitted information appears on the Remittance Advice (RA).
27. Accept Assignment?RequiredThe accept assignment indicates that the provider agrees to accept assignment under the terms of the payer's program.
28. Total ChargeRequiredEnter the sum of all charges listed in field 24F. Do not use commas when reporting dollar amounts. Enter 00 in the cents area if the amount is a whole number.
29. Amount PaidNot Required 
30. Rsvd for NUCC Use  
31. Signature of Physician or Supplier Including Degrees or CredentialsRequiredEach claim must bear the signature of the enrolled provider or the signature of a registered authorized agent.

Each claim must have the date the enrolled provider or registered authorized agent signed the claim form. Enter the date the claim was signed using two digits for the month, two digits for the date and two digits for the year. Example: 070116 for July 1, 2016.
32. 32- Service Facility Location Information
32a- NPI Number
32b- Other ID #
ConditionalEnter the name, address and ZIP code of the individual or business where the member was seen or service was performed in the following format:
1st Line Name
2nd Line Address
3rd Line City, State and ZIP Code
If the Provider Type is not able to obtain an NPI, enter the eight-digit Health First Colorado provider number of the individual or organization.
33. Billing Provider
Info & Ph #
RequiredEnter the name of the individual or organization that will receive payment for the billed services in the following format:
1st Line Name
2nd Line Address
3rd Line City, State and ZIP Code
33a- NPI NumberRequired 
33b- Other ID # If the Provider Type is not able to obtain an NPI, enter the eight-digit Health First Colorado provider number of the individual or organization.

 

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Timely Filing

Refer to the General Provider Information Manual located on the Billing Manuals web page under the General Provider Information drop-down for more information on timely filing policy, including the resubmission rules for denied claims.

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HCBS IDD and TCM for HCBS Waiver Programs Manual Revisions Log

Revision DateAddition/ChangesMade by
12/1/2016Manual revised for interChange implementation. For manual revisions prior to 12/01/2016, please refer to Archive.HPE (now DXC)
12/27/2016Updates based on Colorado iC Stage II Provider Billing Manual Comment Log v0_2.xlsxHPE (now DXC)
1/10/2017Updates based on Colorado iC Stage Provider Billing Manual Comment Log v0_3.xlsxHPE (now DXC)
1/19/2017Updates based on Colorado iC Stage Provider Billing Manual Comment Log v0_4.xlsxHPE (now DXC)
1/26/2017Updates based on Department 1/20/2017 approval emailHPE (now DXC)
5/22/2017Updates based on Fiscal Agent name change from HPE to DXCDXC
12/13/2017Updates for addition of the modifier codes under the SLS Behavioral Plan assessment provided by DepartmentDXC
6/26/2018Updated timely filingHCPF
6/28/2018Updated claims submissionsHCPF
7/31/2018Updated program benefits to reflect benefits no longer under waiver services but in state plan, removed benefits (behavioral, vision, dental and personal care) from appropriate tables and program lists for CES, SLS, DDHCPF
12/21/2018Clarification to signature requirementsHCPF
3/19/2019Clarification to signature requirementsHCPF
7/2/2019Updated Appendices' links and verbiageDXC
12/4/2019Updated CES and SLS service unitsHCPF
12/27/2019Removed references to CCMS/DDDWeb, Special Program Code. Added CHRP as waiver for which TCM is billed, added requirement for U4 Modifier for TCM related to SCR 44697.HCPF
3/3/2020Converted to web pageHCPF
3/4/2020Updated SLS to include (4) transition services to SLS and Youth Day to CESHCPF
6/4/2020Updated coding and language description for TCM, removed references to Special Program Code, minor edits.HCPF
7/27/2020Added POS 11 to 24BHCPF
9/14/2020Added Line to Box 32 under the Paper Claim Reference TableHCPF
12/1/2020Added Tier 3 SCC and SpecHab procedure/modifier combinations to the DD and SLS waivers.HCPF
9/7/2021Added PRC/GJRC-specific procedure/modifier combinations for GRSS, Tier II Spec Hab, and Tier II SCC.HCPF
12/3/2021Added Remote Supports as benefit.HCPF
1/27/2022Removed Remote Supports as benefit.HCPF
2/24/2022Correction of typo - modifier "HR" to "HB"HCPF
3/7/2022Added Remote Supports as a benefitHCPF
3/10/2022Correction to SCC codingHCPF
7/6/2022Updated SLS Services and SLS Procedure Code Table to include CDASS, added subsection under PAR submission to include CDASS PAR instructions; changed code for Rural Travel add-on for TCM benefit.HCPF
10/3/2022Added Specialty numbers and arranged services as appropriateHCPF
10/31/2022Corrected TCM UnitsHCPF
4/3/2023Updated AWS URL LinksHCPF
4/13/2023Add new Home Delivered Meal codesHCPF
7/6/2023Benefits Planning Codes addedHCPF
09/01/2023Language, TCM codes updated relative to Case Management RedesignHCPF
12/20/2023Added Parental Provision codesHCPF
2/12/2024Added Respite Additional ServicesHCPF
2/27/2024Added Denver County codes for Transportation and added new PERS codesHCPF
4/25/2024Added new Denver County codes and completed corrections.HCPF
6/23/2024Removed references to CCBs, aligned allowable, billable procedure codes with Case Management Redesign.HCPF
7/19/2024Added duplicate claims language to Claims Submissions and CES Assistive Technology Service code. Removed Specialized Habilitation Tier 3 and Hippotherapy. Changed Remote Supports codes, updated requirements around days to enter documentation.HCPF