- Program Overview: Home and Community-Based Services
- Prior Authorization Requests (PARs)
- Claim Submission
- HCBS-DD Procedure Code Table
- HCBS-SLS Procedure Code Table
- CES Procedure Code Table
- TCM Procedure Code Table
- HCBS- CES, CHRP, DD and SLS Paper Claim Reference Table
- Timely Filing
- HCBS IDD and TCM for HCBS Waiver Programs Manual Revisions Log
Return to Billing Manuals Web Page
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.
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)
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
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
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.
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.
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).
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)
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.
HCBS-DD Procedure Code Table
Providers may bill the following procedure codes for HCBS-DD services:
Description | Procedure Code | Modifier(s) | Level | Unit 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) | S5100 | U3, HB | All Levels | 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 | 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) | T2019 | U3, SC | All Levels | 15 Minutes |
Job Development (Group) - Outside Denver County | H2023 | U3, HQ | ||
Job Development (Group) - Denver County | H2023 | U3, HQ, HX | ||
Job Development (Individual) - Outside Denver County | H2023 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 County | H2023 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) | H2024 | U3, HQ | All Levels | Dollar |
Job Placement (Individual) | H2024 | U3 | All Levels | Dollar |
Workplace Assistance | T2019 | U3, HB | All Levels | 15 Minutes |
Specialty 669: Prevocational Services | ||||
Pre-Vocational Services | T2015 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) | T2004 | U3 | Single | Dollar |
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 Staff | H2019 | U3 | Single | 15 Minutes |
Behavioral Consultation | H2019 | U3, 22, TG | All Levels | 15 Minutes |
Behavioral Counseling (Individual) | H2019 | U3, TF, TG | All Levels | 15 Minutes |
Behavioral Counseling (Group) | H2019 | U3, TF, HQ | All Levels | 15 Minutes |
Behavioral Plan Assessment | T2024 | U3, 22 | All Levels | 15 Minutes |
Specialty 667: Specialized Medical Equipment and Supplies | ||||
Disposable Supplies | T2028 | U3 | All Levels | Dollar |
Equipment | T2029 | U3 | All Levels | Dollar |
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/Preventative | D2999 | U3 | All Levels | Dollar |
Major | D2999 | U3, 22 | All Levels | Dollar |
Specialty 687: Vision | ||||
Vision *Vision services for individuals aged 18-20 on the DD waiver must be accessed through state plan benefits or EPSDT. | V2799 | U3 | All Levels | Dollar |
Specialty 752: Home Delivered Meals | ||||
Home Delivered Meals | S5170 | U3 | 1 unit = 1 meal | |
Home Delivered Meals after 1st discharge from a 24hr hospitalization | S5170 | U3, TF | All levels | 1 unit = 1 meal |
Home Delivered Meals after 2nd discharge from a 24hr hospitalization | S5170 | U3, TG | All levels | 1 unit = 1 meal |
Specialty 754: Peer Mentorship | ||||
Peer Mentorship | H2015 | U3 | 1 unit = 15 minutes | |
Specialty 744: Benefits Planning | ||||
Benefits Planning | T2019 | U3, HI | All Levels | 1 unit = 15 minutes |
Specialty 636: Community Transition Services | ||||
Coordinator | T2038 | U3 | All levels | 15 minutes |
Setup Expenses | A9900 | U3 | All levels | One-time Payment |
HCBS-SLS Procedure Code Table
Description | Procedure Code | Modifier(s) | Level | Unit Designation |
---|---|---|---|---|
Specialty 664: Personal Care | ||||
Personal Care | T1019 | U8 | All Levels | 15 Minutes |
Specialty 676: Respite | ||||
Individual – Outside Denver County | S5150 S5151 | U8 U8 | All Levels All Levels | 15 Minutes Day |
Individual – Denver County | S5150 S5151 | U8, HX U8, HX | All Levels All Levels | 15 Minutes Day |
Group | S5151 | U8, HQ | All Levels | Dollar |
Group Overnight (Camp) | T2036 | U8 | All Levels | Dollar |
Specialty 652: Homemaker | ||||
Basic – Outside Denver County | S5130 | U8 | All Levels | 15 Minutes |
Basic – Denver County | S5130 | U8, HX | All Levels | 15 Minutes |
Enhanced – Outside Denver County | S5130 | U8, 22 | All Levels | 15 Minutes |
Enhanced – Denver County | S5130 | U8, 22, HX | All Levels | 15 Minutes |
Specialty 702: Consumer Directed Attendant Support Services (CDASS) | ||||
CDASS, Non – Health Maintenance (Cent / Unit) | T2025 | U8 | All Levels | 1 unit = $0.01 |
CDASS, Health Maintenance (Cent / Unit) | T2025 | U8, SE | All Levels | 1 unit = $0.01 |
CDASS Per Member / Per Month | T2040 | U8 | All Levels | 1 unit = 1 month |
Specialty 659: Mentorship | ||||
Mentorship, Denver County | H2021 | U8 | All Levels All Levels | 15 Minutes 15 Minutes |
Mentorship, Outside Denver County | H2021 | U8, HX | All 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) | S5100 | U8, HB | All Levels | 15 Minutes |
Specialty 669: Prevocational Services | ||||
Pre-Vocational Services | T2015 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) | T2019 | U8, SC | All Levels | 15 Minutes |
SE Job Development- Group – Outside Denver County | H2023 | U8, HQ | All Levels | 15 Minutes |
SE Job Development- Group – Denver County | H2023 | U8, HQ, HX | All Levels | 15 Minutes |
SE Job Development- Individual | H2023 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 County | H2023 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- Group | H2024 | U8, HQ | All Levels | Dollar |
SE Job Placement- Individual | H2024 | U8 | All Levels | Dollar |
Workplace Assistance | T2019 | U8, HB | All Levels | 1 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 Program | T2003 | U8, SC | All Distances | Trip |
Other (Public Conveyance) | T2004 | U8 | All Distances | Dollar |
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 Staff | H2019 | U8 | All Levels | 15 Minutes |
Behavioral Consultation | H2019 | U8, 22, TG | All Levels | 15 Minutes |
Behavioral Counseling (Individual) | H2019 | U8, TF, TG | All Levels | 15 Minutes |
Behavioral Counseling (Group) | H2019 | U8, TF, HQ | All Levels | 15 Minutes |
Behavioral Plan Assessment | T2024 | U8, 22 | All Levels | 15 Minutes |
PROFESSIONAL SERVICES | ||||
Specialty 729: Professional Services - Massage Therapy | ||||
Massage Therapy | 97124 | U8 | All Levels | 15 Minutes |
Specialty 672: Professional Services - Movement Therapy | ||||
Movement Therapy Bachelors Movement Therapy Masters | G0176 G0176 | U8 U8, 22 | All Levels | 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 600: Adaptive Therapeutic Recreation Equipment/Fees | ||||
Recreational Facility Fees/Passes | S5199 | U8 | All Levels | Dollar |
Specialty 677: Specialized Medical Equipment and Supplies (SMES) | ||||
Supplies and Disposable | T2028 | U8 | All Levels | Dollar |
Equipment | T2029 | U8 | All Levels | Dollar |
Specialty 668: Personal Emergency Response (PERS) | ||||
Monitoring | S5161 | U8 | All Levels | Month |
Install/Purchase | S5160 | U8 | All Levels | Purchase |
Specialty 756: Remote Supports | ||||
Remote Support Service | O593T | U8 | All Levels | 15 Minutes |
Remote Supports Technology (Install/purchase) | A9279 | U8 | All Levels | Monthly Purchase |
Specialty 648: Home Accessibility Adaptations | ||||
Home Accessibility Adaptations | S5165 | U8 | All Levels | 1 unit = half of each modification |
Specialty 685: Vehicle Modifications | ||||
Vehicle Modifications | T2039 | U8 | All Levels | Dollar |
Specialty 607: Assistive Technology | ||||
Assistive Technology | T2035 | U8 | All Levels | Dollar |
Specialty 749: Dental *Dental Services for individuals aged 18-20 on the SLS waiver must be accessed through state plan benefits or EPSDT. | ||||
Basic / Preventative | D2999 | U8 | All Levels | Dollar |
Major | D2999 | U8, 22 | All Levels | Dollar |
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. | V2799 | U8 | All Levels | Dollar |
Specialty 636: Community Transition Services | ||||
Coordinator | T2038 | U8 | All Levels | 15 Minutes |
Setup Expenses | A9900 | U8 | All Levels | One-time Payment |
Specialty 754: Peer Mentorship | ||||
Home Delivered Meals | S5170 | U8 | All Levels | Per Meal |
Home Delivered Meals after 1st discharge from a 24-hr hospitalization | S5170 | U8, TF | All Levels | 1 unit = 1 meal |
Home Delivered Meals after 2nd discharge from a 24-hr hospitalization | S5170 | U8, TG | All Levels | 1 unit = 1 meal |
Specialty 752: Home Delivered Meals | ||||
Life Skills Training | H2014 | U8 | All Levels | 15 Minutes |
Specialty 753: Life Skills Training | ||||
Peer Mentorship | H2015 | U8 | All Levels | 15 Minutes |
Specialty 744: Benefits Planning | ||||
Benefits Planning | T2019 | U8, HI | All Levels | 1 unit = 15 minutes |
CES Procedure Code Table
Providers may bill the following procedure codes for HCBS-CES services:
Description | Procedure Code | Modifier(s) | Unit Designation |
---|---|---|---|
Specialty 676: Respite | |||
Individual – Outside Denver County | S5150 S5151 | U7 U7 | 15 Minutes Day |
Individual – Denver County | S5150 S5151 | U7, HX U7, HX | 15 Minutes Day |
Group | S5151 | U7, HQ | Dollar |
Group Overnight (Camp) | T2036 | U7 | Dollar |
Specialty 751: Youth Day | |||
Individual | T2027 | U7 | 15 Minutes |
Group | T2027 | U7, HQ | 15 Minutes |
Specialty 652: Homemaker | |||
Basic – Outside Denver County | S5130 | U7 | 15 Minutes |
Basic – Denver County | S5130 | U7, HX | 15 Minutes |
Enhanced – Outside Denver County | S5130 | U7, 22 | 15 Minutes |
Enhanced – Denver County | S5130 | U7, 22, HX | 15 Minutes |
Homemaker Basic Parental Provision – Outside Denver County | S5130 | U7, HA, HI | 15 Minutes |
Homemaker Basic Parental Provision – Denver County | S5130 | U7, HA, HI, HX | 15 Minutes |
Homemaker Enhanced Parental Provision – Outside Denver County | S5130 | U7, HA | 15 Minutes |
Homemaker Enhanced Parental Provision – Denver County | S5130 | U7, HA, HX | 15 Minutes |
Specialty 634: Community Connector | |||
Community Connector – Outside Denver County | H2021 | U7 | 15 Minutes |
Community Connector – Denver County | H2021 | U7 | 15 Minutes |
Community Connector Parental Provision – Outside Denver County | H2021 | U7, HA | 15 Minutes |
Community Connector Parental Provision – Denver County | H2021 | U7, HA, HX | 15 Minutes |
Specialty 729: Professional Services - Massage Therapy | |||
Massage Therapy | 97124 | U7 | 15 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 Adaptations | S5165 | U7 | 1 unit = half of each modification |
Specialty 685: Vehicle Modifications | |||
Vehicle Modifications | T2039 | U7 | Dollar |
Specialty 607: Assistive Technology | |||
Assistive Technology | T2035 | U7 | Dollar |
Assistive Technology Device | T2035 | U7 SE | Dollar |
Specialty 662: Caregiver Education | |||
Caregiver Education | H1010 | U7 | Dollar / $1,000 Max. Year |
Specialty 882: CHRP Youth Mentorship-CES/CHRP Therapeutic Respite | |||
Skilled Therapeutic (4 hours or less) - Outside Denver County | T1005 | U7, HA | 15 Minutes |
Skilled Therapeutic (4 hours or less) - Denver County | T1005 | U7, HA, HX | 15 Minutes |
Skilled Therapeutic (4 hours or more) - Outside Denver County | S9125 | U7, HA | Day |
Skilled Therapeutic (4 hours or more) - Denver County | S9125 | U7, HA, HX | Day |
Specialty 615: Skilled Respite | |||
Skilled CNA (4 hours or less) - Outside Denver County | T1005 | U7 | 15 Minutes |
Skilled CNA (4 hours or less) - Denver County | T1005 | U7, HX | 15 Minutes |
Skilled RN, LPN (4 hours or less) - Outside Denver County | T1005 | U7, TD | 15 Minutes |
Skilled RN, LPN (4 hours or less) - Denver County | T1005 | U7, TD, HX | 15 Minutes |
Skilled CNA (4 hours or more) - Outside Denver County | S9125 | U7 | Day |
Skilled CNA (4 hours or more) - Denver County | S9125 | U7, HX | Day |
Skilled RN, LPN (4 hours or more) - Outside Denver County | S9125 | U7, TD | Day |
Skilled RN, LPN (4 hours or more) - Denver County | S9125 | U7, TD, HX | Day |
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.
Description | Procedure Code | Modifier(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 month | T2023 | HI | 1 Unit, maximum of 12 units per service plan year |
Targeted Case Management - Monitoring Visit (in-person) | T2024 | HI | 1 Unit, Maximum of four (4) units per service plan year |
Targeted Case Management – Monitoring Visit (telephone, video, etc.) | T2024 | HI, GT | 1 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 HCPF | A0170 | HI | 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 |
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 Label | Field is? | Instructions | ||||||||||||||||||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1. Insurance Type | Required | Place an "X" in the box marked as Medicaid. | ||||||||||||||||||||||||||||||||||||
1a. Insured's ID Number | Required | Enter 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 Name | Required | Enter the member's last name, first name, and middle initial. | ||||||||||||||||||||||||||||||||||||
3. Patient's Date of Birth/Sex | Required | Enter 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 Name | Not required | |||||||||||||||||||||||||||||||||||||
5. Patient's Address | Not Required | |||||||||||||||||||||||||||||||||||||
6. Client Relationship to Insured | Not Required | |||||||||||||||||||||||||||||||||||||
7. Insured's Address | Not Required | |||||||||||||||||||||||||||||||||||||
8. Reserved for NUCC Use | Not Required | |||||||||||||||||||||||||||||||||||||
9. Other Insured's Name | Not Required | |||||||||||||||||||||||||||||||||||||
9a. Other Insured's Policy or Group Number | Not Required | |||||||||||||||||||||||||||||||||||||
9b. Reserved for NUCC Use | ||||||||||||||||||||||||||||||||||||||
9c. Reserved for NUCC Use | ||||||||||||||||||||||||||||||||||||||
9d. Insurance Plan or Program Name | Not Required | |||||||||||||||||||||||||||||||||||||
10a-c. Is patient's condition related to? | Not Required | |||||||||||||||||||||||||||||||||||||
10d. Reserved for Local Use | ||||||||||||||||||||||||||||||||||||||
11. Insured's Policy, Group or FECA Number | Not Required | |||||||||||||||||||||||||||||||||||||
11a. Insured's Date of Birth, Sex | Not Required | |||||||||||||||||||||||||||||||||||||
11b. Other Claim ID | Not Required | |||||||||||||||||||||||||||||||||||||
11c. Insurance Plan Name or Program Name | Not Required | |||||||||||||||||||||||||||||||||||||
11d. Is there another Health Benefit Plan? | Not Required | |||||||||||||||||||||||||||||||||||||
12. Patient's or Authorized Person's signature | Required | Enter "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 Signature | Not Required | |||||||||||||||||||||||||||||||||||||
14. Date of Current Illness Injury or Pregnancy | Not Required | |||||||||||||||||||||||||||||||||||||
15. Other Date | Not Required | |||||||||||||||||||||||||||||||||||||
16. Date Patient Unable to Work in Current Occupation | Not Required | |||||||||||||||||||||||||||||||||||||
17. Name of Referring Physician | Conditional | |||||||||||||||||||||||||||||||||||||
18. Hospitalization Dates Related to Current Service | Not Required | |||||||||||||||||||||||||||||||||||||
19. Additional Claim Information | Conditional | |||||||||||||||||||||||||||||||||||||
20. Outside Lab? $ Charges | Not Required | |||||||||||||||||||||||||||||||||||||
21. Diagnosis or Nature of Illness or Injury | Required | Enter 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 Code | Conditional | List 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 Authorization | Not Required | HCBS Leave blank. | ||||||||||||||||||||||||||||||||||||
24. Claim Line Detail | Information | The 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 Service | Required | 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.
or
Span dates of service
Practitioner claims must be consecutive days. | ||||||||||||||||||||||||||||||||||||
24B. Place of Service | Required | 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.
| ||||||||||||||||||||||||||||||||||||
24C. EMG | Not Required | |||||||||||||||||||||||||||||||||||||
24D. Procedures, Services, or Supplies | Required | Enter the procedure code that specifically describes the service for which payment is requested. HCBS Refer to the HCBS-DD, HCBS-CES, HCBS-SLS or TCM procedure code tables. | ||||||||||||||||||||||||||||||||||||
24D. Modifier | Required | Enter 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 Pointer | Required | Enter 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. $ Charges | Required | Enter 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 Units | Required | Enter the number of services provided for each procedure code. Enter whole numbers only- do not enter fractions or decimals. | ||||||||||||||||||||||||||||||||||||
24G. Days or Units | General Instructions | A 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 Plan | Not Required | |||||||||||||||||||||||||||||||||||||
24I. ID Qualifier | Not Required | |||||||||||||||||||||||||||||||||||||
24J. Rendering Provider ID # | Required | In 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 Number | Not Required | |||||||||||||||||||||||||||||||||||||
26. Patient's Account Number | Optional | Enter information that identifies the member or claim in the provider's billing system. Submitted information appears on the Remittance Advice (RA). | ||||||||||||||||||||||||||||||||||||
27. Accept Assignment? | Required | The accept assignment indicates that the provider agrees to accept assignment under the terms of the payer's program. | ||||||||||||||||||||||||||||||||||||
28. Total Charge | Required | Enter 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 Paid | Not Required | |||||||||||||||||||||||||||||||||||||
30. Rsvd for NUCC Use | ||||||||||||||||||||||||||||||||||||||
31. Signature of Physician or Supplier Including Degrees or Credentials | Required | Each 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 # | Conditional | Enter 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 # | Required | Enter 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 Number | Required | |||||||||||||||||||||||||||||||||||||
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. |
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.
HCBS IDD and TCM for HCBS Waiver Programs Manual Revisions Log
Revision Date | Addition/Changes | Made by |
---|---|---|
12/1/2016 | Manual revised for interChange implementation. For manual revisions prior to 12/01/2016, please refer to Archive. | HPE (now DXC) |
12/27/2016 | Updates based on Colorado iC Stage II Provider Billing Manual Comment Log v0_2.xlsx | HPE (now DXC) |
1/10/2017 | Updates based on Colorado iC Stage Provider Billing Manual Comment Log v0_3.xlsx | HPE (now DXC) |
1/19/2017 | Updates based on Colorado iC Stage Provider Billing Manual Comment Log v0_4.xlsx | HPE (now DXC) |
1/26/2017 | Updates based on Department 1/20/2017 approval email | HPE (now DXC) |
5/22/2017 | Updates based on Fiscal Agent name change from HPE to DXC | DXC |
12/13/2017 | Updates for addition of the modifier codes under the SLS Behavioral Plan assessment provided by Department | DXC |
6/26/2018 | Updated timely filing | HCPF |
6/28/2018 | Updated claims submissions | HCPF |
7/31/2018 | Updated 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, DD | HCPF |
12/21/2018 | Clarification to signature requirements | HCPF |
3/19/2019 | Clarification to signature requirements | HCPF |
7/2/2019 | Updated Appendices' links and verbiage | DXC |
12/4/2019 | Updated CES and SLS service units | HCPF |
12/27/2019 | Removed 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 |
3/3/2020 | Converted to web page | HCPF |
3/4/2020 | Updated SLS to include (4) transition services to SLS and Youth Day to CES | HCPF |
6/4/2020 | Updated coding and language description for TCM, removed references to Special Program Code, minor edits. | HCPF |
7/27/2020 | Added POS 11 to 24B | HCPF |
9/14/2020 | Added Line to Box 32 under the Paper Claim Reference Table | HCPF |
12/1/2020 | Added Tier 3 SCC and SpecHab procedure/modifier combinations to the DD and SLS waivers. | HCPF |
9/7/2021 | Added PRC/GJRC-specific procedure/modifier combinations for GRSS, Tier II Spec Hab, and Tier II SCC. | HCPF |
12/3/2021 | Added Remote Supports as benefit. | HCPF |
1/27/2022 | Removed Remote Supports as benefit. | HCPF |
2/24/2022 | Correction of typo - modifier "HR" to "HB" | HCPF |
3/7/2022 | Added Remote Supports as a benefit | HCPF |
3/10/2022 | Correction to SCC coding | HCPF |
7/6/2022 | Updated 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 |
10/3/2022 | Added Specialty numbers and arranged services as appropriate | HCPF |
10/31/2022 | Corrected TCM Units | HCPF |
4/3/2023 | Updated AWS URL Links | HCPF |
4/13/2023 | Add new Home Delivered Meal codes | HCPF |
7/6/2023 | Benefits Planning Codes added | HCPF |
09/01/2023 | Language, TCM codes updated relative to Case Management Redesign | HCPF |
12/20/2023 | Added Parental Provision codes | HCPF |
2/12/2024 | Added Respite Additional Services | HCPF |
2/27/2024 | Added Denver County codes for Transportation and added new PERS codes | HCPF |
4/25/2024 | Added new Denver County codes and completed corrections. | HCPF |
6/23/2024 | Removed references to CCBs, aligned allowable, billable procedure codes with Case Management Redesign. | HCPF |
7/19/2024 | Added 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 |