1

Laboratory Services Billing Manual

Return to Billing Manuals Web Page

 

Laboratory Services

Providers must be enrolled as a Health First Colorado (Colorado's Medicaid program) provider in order to:

  • Treat a Health First Colorado member
  • Submit claims for payment to Health First Colorado

A certified clinical laboratory means a provider who possesses a certificate of waiver or a certificate of registration from the Centers for Medicare & Medicaid Services (CMS) or its designated agency as meeting CMS guidelines and whose personnel and director are qualified to perform laboratory services.

An independent laboratory means a certified clinical laboratory that performs diagnostic tests and is independent both of the attending or consulting physician's office and of a hospital.

All clinical laboratory providers must furnish their Clinical Laboratory Improvement Amendment (CLIA) certification numbers to the Health First Colorado fiscal agent at the time of enrollment.

Medically necessary, physician-ordered laboratory services are a benefit of Health First Colorado.

Providers should refer to the Code of Colorado Regulations, Program Rules (10 CCR 2505-10), for specific information when providing laboratory services.

Important: Laboratory services for Emergency Medicaid (EMS) clients must include the emergency indicator on the claim for the claim to be paid.

Back to Top

 

General Billing Information

Refer to the General Provider Information Manual located on the Billing Manuals web page for general billing information.

Back to Top

 

Ordering, Prescribing and Referring (OPR) Providers 

Health First Colorado complies with Federal Medicaid Regulations in 42 CFR 455.410(b) which provide that Medicaid must require all ordering or referring physicians or other professionals providing services be enrolled as providers, and 42 CFR 455.440, which provides that Medicaid must require all claims for the payment of items and services that were ordered, prescribed and referred to include the National Provider Identifier (NPI) of the OPR physician or other professional.

Effective July 1, 2022, the Department of Health Care Policy & Financing (the Department) will enforce the federal requirement 42 CFR § 455.440 that claims for all Laboratory services, rendered by any type of provider, contain the NPI of the provider who ordered the services, and that the NPI is actively enrolled with Health First Colorado. The ordering NPI may be that of the qualified provider overseeing the member’s care, for example as is the case with maternity services.   

Providers are instructed to place the NPI of the ordering provider into the following locations for claim submission: 

Professional Claims

  • Paper claims use field 17.b
  • Electronic submissions use loop 2420e with qualifier DK

Laboratory services can be ordered by either a physician, physician assistant, osteopath, certified nurse midwife, or advanced practice nurse. The ordering provider must also be actively enrolled with Health First Colorado. If these conditions are not met the claim will be denied. 

Visit the OPR web page for further information on this project.

Back to Top

 

Unlisted Procedure Codes

Unlisted laboratory procedure codes are used when there is no CPT or HCPCS code that accurately identifies the services performed. Unlisted procedure codes will be priced by a clinical reviewer with the Department's fiscal agent.

Claims with unlisted codes must include as attachments the operating report from the procedure and the Unlisted Procedure Code Form, located on the Provider Forms web page under the Claim Forms and Attachments drop-down. All lines on the Unlisted Procedure Code Form must be completed. The Department will deny claims lacking the required attachments. Claims denied for incomplete information will have to be resubmitted with the correct information for reimbursement.

Back to Top

 

General Prior Authorization Requirements

Refer to the General Provider Information Manual located on the Billing Manual web page for information about prior authorization requirements. Visit the ColoradoPAR web page for more information or visit the Provider Contacts web page for contact information.

Back to Top

 

Laboratory Prior Authorized Procedure Codes

Below is a list of prior authorized procedure codes for laboratory billing. Reference the current Fee Schedule for rates.

Note: This table serves as a reference guide only and not a guarantee of payment or coverage. Definitive coverage of a specific procedure code is found on the Fee Schedule.

Last table update: 01/10/2020

Procedure CodeNotesProcedure CodeNotes
81162PAR required as of 1/1/201681295PAR required as of 2/10/2020
81163PAR required as of 1/1/201981296PAR required as of 2/10/2020
81164PAR required as of 1/1/201981297PAR required as of 2/10/2020
81165PAR required as of 1/1/201981298PAR required as of 2/10/2020
81166PAR required as of 1/1/201981299PAR required as of 2/10/2020
81167PAR required as of 1/1/201981300PAR required as of 2/10/2020
81200PAR required as of 2/10/202081306PAR required as of 1/1/2019
81201PAR required as of 7/1/201981307PAR required as of 1/1/2020
81209PAR required as of 2/10/202081308PAR required as of 1/1/2020
81211Coverage terminated 12/31/201881309PAR required as of 1/1/2020
81212PAR required as of 7/1/201581312PAR required as of 1/1/2019
81213Coverage terminated 12/31/201881317PAR required as of 7/1/2019
81214Coverage terminated 12/31/201881318PAR required as of 2/10/2020
81215PAR required as of 7/1/201581319PAR required as of 2/10/2020
81216PAR required as of 7/1/201581321PAR required as of 7/1/2019
81217PAR required as of 7/1/201581323PAR required as of 2/10/2020
81220No PAR required as of 09/01/202381327PAR required as of 2/10/2020
81241PAR required as of 2/10/202081380PAR required as of 2/10/2020
81242PAR required as of 7/1/201981400PAR required as of 2/10/2020
81243PAR required as of 2/10/202081401PAR required as of 2/10/2020
81251PAR required as of 2/10/202081402PAR required as of 2/10/2020
81255PAR required as of 2/10/202081403PAR required as of 7/1/2019
81256PAR required as of 2/10/202081404PAR required as of 7/1/2019
81257PAR required as of 2/10/202081405PAR required as of 7/1/2019
81260PAR required as of 2/10/202081406PAR required as of 2/10/2020
81277PAR required as of 1/1/202081407PAR required as of 2/10/2020
81283PAR required as of 2/10/202081408PAR required as of 7/1/2019
81290PAR required as of 2/10/202081420PAR required between 2/10/2020 and 6/30/2022
81292PAR required as of 7/1/201981432PAR required as of 2/10/2020
81293PAR required as of 2/10/202081522PAR required as of 1/1/2020
81294PAR required as of 2/10/202081542PAR required as of 1/1/2020

 

Back to Top

 

Clinical Laboratory Improvement Amendments (CLIA) Claims

Laboratory providers submitting procedures covered by CLIA must have a CLIA number of the laboratory where the procedure was done on the claim or claim line. Pass-through billing is not allowed per the Laboratory and X-ray rule found at 10 CCR 2505-10 8.660.

  • Providers billing on the 837P format should refer to the updated 837P Companion Guide located on the EDI Support web page. Providers billing on the 837P format and billing agents should update their billing systems for 837P transactions.
  • Providers billing an 837P through the Health First Colorado Online Portal (Online Portal) are able to enter CLIA numbers on the Detail Line Item tab (claim line).
  • Providers billing on the CMS 1500 paper claim form should enter their valid CLIA number in the REMARKS field (# 23). Enter "CLIA" before the CLIA number.

Note: Only one CLIA number can be included on each paper claim form. It is applied to all CLIA covered procedures on the claim. Procedures covered by different CLIA numbers need to be submitted on separate claims. Enter the CLIA number in the REMARKS field only.

The Tax ID (TID) on record with the Centers for Medicare & Medicaid Services (CMS) for the CLIA number must correspond to the TID on record with the Department. Questions regarding claims processing or responses should be directed to Gainwell Technologies.

Back to Top

 

Handling, Collection and Conveyance Charges

Specimen collection (including venipuncture) is considered to be an integral part of the laboratory testing procedure when performed by a laboratory and is generally not reimbursable as a separate or additional charge.

Transfer of a specimen from one clinical laboratory to another is a benefit only if the first laboratory's equipment is not functioning or the laboratory is not certified to perform the ordered tests. Modifier -KX used with procedure code 99001 verifies that the lab's equipment is not functioning or that the laboratory is not certified to perform the ordered test.

Specimen collection, handling, and conveyance from the member's home, a nursing facility, or a facility other than the physician's office or place of service is a benefit only if the member is homebound, bedfast, or otherwise non-ambulatory and the specimen cannot reasonably be conveyed by mail. A physician's statement explaining the circumstances and medical necessity is required.

Each laboratory will be reimbursed only for those tests performed in the specialties or subspecialties for which it is certified.

Back to Top

 

Papanicolaou (Pap) Smears

Health First Colorado allows one pap smear screening/examination per 12-month period in women under 40 years of age. Benefit for more than one Pap smear in a 12-month period is allowed for women ages 40 and over, women with a history of diethylstilbestrol exposure in utero, women with malignancy of the cervix, vagina, uterus, fallopian tubes or ovaries, women with cervical polyps, cervicitis, neoplastic disease of the pelvic organs, vaginal discharge or bleeding of unknown origin, postmenopausal bleeding, or vaginitis, or if the physician determines that more frequent testing is needed and is medically necessary. Claims will deny if the diagnosis code entered on the claim does not support the testing frequency.

Back to Top

 

Drug Testing Unit Limitations and Documentation Requirements

Current Procedural Terminology (CPT) codes 80305, 80306 and 80307 have a unit limit of four (4) per month per client for each code. This unit limit applies to all provider types.

As of January 2020, substance-specific confirmatory tests no longer require a positive or inconclusive presumptive test or medical necessity documentation attached to the claim to be considered for reimbursement.

As of August 1, 2021, HCPCS G0480-G0483 should be used when billing for substance-specific confirmatory tests. CPT codes 80320-80377 were closed as of July 31, 2021.

Back to Top

 

Newborn Metabolic Screening

Costs associated with Newborn Metabolic Screening (NMS) are included in the inpatient hospital diagnosis-related grouper (DRG) calculation and the birthing center facility payment and may not be billed separately by the hospital or birth center. Billing S3620 while receiving a DRG or facility payment for the delivery is duplicative.

S3620 may only be billed by providers, not reimbursed for the delivery, who submit a second-specimen screen and are charged for an initial-specimen screen by Colorado Department of Public Health & Environment (CDPHE) because the second specimen could not be linked to an initial-specimen. S3620 does not require a CLIA certification.

Because the NMS are performed by CDPHE's laboratory and not the provider collecting and submitting the specimen, unbundling the NMS and billing for the individual tests performed by CDPHE's laboratory is not allowed per the Laboratory and X-ray rule found at 10 CCR 2505-10 8.660.

Back to Top

 

BRCA Screening and Testing

Per the Women's Health Services rule found at 10 CCR 2505-10 8.731, the following are requirements for BRCA screening and testing:

  • BRCA screening, genetic counseling and testing is only covered for clients over the age of 18.
  • BRCA screening is covered and must be conducted prior to any BRCA-related genetic testing.
  • The provider shall make genetic counseling available to clients with a positive screening both before and after genetic testing, if the provider is able, and genetic counseling is within the provider's scope of practice. If the provider is unable to provide genetic counseling, the provider shall refer the client to a genetic counselor*.
  • Genetic testing for breast cancer susceptibility genes BRCA1 and BRCA2 is covered for clients with a positive screening.

*Genetic Counselors cannot be directly reimbursed for services. A supervising physician may be reimbursed. The services require direct supervision if done by a genetic counselor, with the supervisor on site.

Back to Top

 

Prenatal Testing

Effective July 1, 2022, Genetic Screening, including but not limited to Non-Invasive Prenatal Testing (NIPT), and Genetic Counseling are covered in accordance with nationally recognized standards of care per the American College of Obstetricians and Gynecologists. Screening coverage is available for women carrying a singleton gestation who meet national standard guidelines.

Coverage of this service was available under more specific criteria prior to June 30, 2022. 

Back to Top

 

General Requirements

  • Fees for blood drawing, specimen collection, or handling are generally not reimbursable to laboratories.
  • The provider who actually performs the laboratory procedure is the only one who is eligible to bill and receive payment. Physicians may only bill for tests actually performed in their office or clinic. Tests performed by laboratories or hospital outpatient laboratories must be billed by the performing laboratory.
  • CPT identifies tests that can be and are frequently done as groups and combinations ("profiles") on automated multi-channel equipment. For any combination of tests among those listed, use the appropriate Level 1 or Level 2 CMS codes.
  • For organ or disease-oriented panels (check CPT narrative), use the appropriate Level 1 CMS codes. These tests are not to be performed or billed separately when ordered in a group/combination and must be billed with one unit of service.

Back to Top

 

Procedure/HCPCS Codes Overview

The Department accepts procedure codes that are approved by the Centers for Medicare & Medicaid Services (CMS). The codes are used for submitting claims for services provided to Health First Colorado members and represent services that may be provided by enrolled certified Health First Colorado providers.

The Healthcare Common Procedural Coding System (HCPCS) is divided into two principal subsystems, referred to as level I and level II of the HCPCS. Level I of the HCPCS is comprised of Current Procedural Terminology (CPT), a numeric coding system maintained by the American Medical Association (AMA). The CPT is a uniform coding system consisting of descriptive terms and identifying codes that are used primarily to identify medical services and procedures furnished by physicians and other health care professionals. Level II of the HCPCS is a standardized coding system that is used primarily to identify products, supplies, and services not included in the CPT codes, such as ambulance services and durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) when used outside a physician's office. Level II codes are also referred to as alpha-numeric codes because they consist of a single alphabetical letter followed by 4 numeric digits, while CPT codes are identified using 5 numeric digits.

HIPAA requires providers to comply with the coding guidelines of the AMA CPT Procedure Codes and the International Classification of Disease, Clinical Modification Diagnosis Codes. If there is no time designated in the official descriptor, the code represents one unit or session. Providers should regularly consult monthly bulletins located on the Bulletins web page. To receive electronic provider bulletin notifications, an email address can be entered into the Online Portal in the (MMIS) Provider Data Maintenance area or by completing and submitting a Publication Email Preference Form in the Provider Services Forms section. Bulletins include updates on approved procedures codes as well as the maximum allowable units billed per procedure.

Back to Top

 

Procedure Codes

Services must be reported using HCPCS procedure codes.

Use procedure codes listed in the most recent HCPCS bulletin located on the Bulletins web page.

The fiscal agent updates and revises CMS codes through Health First Colorado bulletins.

Back to Top

 

CMS 1500 Paper Claim Reference Table

The following paper form reference table shows required, optional, and conditional fields and detailed field completion instructions for the CMS 1500 claim form.

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 Health First Colorado ID number as it appears on the Medicaid 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 NameConditionalComplete if the member is covered by a Medicare health insurance policy.

Enter the insured's full last name, first name, and middle initial. If the insured used a last name suffix (e.g., Jr, Sr), enter it after the last name and before the first name.
5. Patient's AddressNot Required 
6. Client Relationship to InsuredConditionalComplete if the member is covered by a commercial health care insurance policy. Place an "X" in the box that identifies the member's relationship to the policyholder.
7. Insured's AddressNot Required 
8. Reserved for NUCC UseNot Required 
9. Other Insured's NameConditionalIf field 11d is marked "YES", enter the insured's last name, first name and middle initial.
9a. Other Insured's Policy or Group NumberConditionalIf field 11d is marked "YES", enter the policy or group number.
9b. Reserved for NUCC Use  
9c. Reserved for NUCC Use  
9d. Insurance Plan or Program NameConditionalIf field 11D is marked "YES", enter the insurance plan or program name.
10a-c. Is patient's condition related to?ConditionalWhen appropriate, place an "X" in the correct box to indicate whether one or more of the services described in field 24 are for a condition or injury that occurred on the job, as a result of an auto accident or other.
10d. Reserved for Local Use  
11. Insured's Policy, Group or FECA NumberConditionalComplete if the member is covered by a Medicare health insurance policy.

Enter the insured's policy number as it appears on the ID card. Only complete if field 4 is completed.
11a. Insured's Date of Birth, SexConditionalComplete if the member is covered by a Medicare health insurance policy.

Enter the insured'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 insured.
11b. Other Claim IDNot Required 
11c. Insurance Plan Name or Program NameNot Required 
11d. Is there another Health Benefit Plan?ConditionalWhen appropriate, place an "X" in the correct box. If marked "YES", complete 9, 9a and 9d.
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 PregnancyConditionalComplete if information is known. Enter the date of illness, injury or pregnancy, (date of the last menstrual period) using two digits for the month, two digits for the date and two digits for the year. Example: 070114 for July 1, 2014.

Enter the applicable qualifier to identify which date is being reported.
431 - Onset of Current Symptoms or Illness
484 - Last Menstrual Period
15. Other Date NotNot Required 
16. Date Patient Unable to Work in Current OccupationNot Required 
17. NPI of Referring Physician or other sourceRequiredRequired in accordance with Program Rule 8.125.8A
18. Hospitalization Dates Related to Current ServiceConditionalComplete for services provided in an inpatient hospital setting. Enter the date of hospital admission and the date of discharge using two digits for the month, two digits for the date and two digits for the year. Example: 070116 for July 1, 2016. If the member is still hospitalized, the discharge date may be omitted. This information is not edited.
19. Additional Claim InformationConditional 
20. Outside Lab?
$ Charges
ConditionalComplete if all laboratory work was referred to and performed by an outside laboratory. If this box is checked, no payment will be made to the physician for lab services. Do not complete this field if any laboratory work was performed in the office.

Practitioners may not request payment for services performed by an independent or hospital laboratory.
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.
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 AuthorizationConditionalCLIA
When applicable, enter the word "CLIA" followed by the number.

Prior Authorization
Enter the six-character prior authorization number from the approved Prior Authorization Request (PAR). Do not combine services from more than one approved PAR on a single claim form. Do not attach a copy of the approved PAR unless advised to do so by the authorizing agent or the fiscal agent.
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: 010119 for January 1, 2019.

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.

Supplemental Qualifier
To enter supplemental information, begin at 24A by entering the qualifier and then the information.
ZZ - Narrative description of unspecified code
VP - Vendor Product Number
OZ - Product Number
CTR - Contract Rate
JP - Universal/National Tooth Designation
JO - Dentistry Designation System for Tooth and Areas of Oral Cavity

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.

81Lab
24C. EMGConditionalEnter a "Y" for YES or leave blank for NO in the bottom, unshaded area of the field to indicate the service is rendered for a life-threatening condition or one that requires immediate medical intervention.

If a "Y" for YES is entered, the service on this detail line is exempt from co-payment requirements.
24D. Procedures, Services, or SuppliesRequiredEnter the HCPCS procedure code that specifically describes the service for which payment is requested.

All procedures must be identified with codes in the current edition of Physicians Current Procedural Terminology (CPT). CPT is updated annually.

HCPCS Level II Codes
The current Medicare coding publication (for Medicare crossover claims only).

Only approved codes from the current CPT or HCPCS publications will be accepted.
24D. ModifierConditional

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.

26Professional component
Use with diagnostic codes to report professional component services (reading and interpretation) billed separately from technical component services.
Report separate professional and technical component services only if different providers perform the professional and technical portions of the procedure.
Read CPT descriptors carefully. Do not use modifiers if the descriptor specifies professional or technical components.
KXSpecific required documentation on file
Use with laboratory codes to certify that the laboratory's equipment is not functioning, or the laboratory is not certified to perform the ordered test. The -KX modifier takes the place of the provider's certification, "I certify that the necessary laboratory equipment was not functioning to perform the requested test", or "I certify that this laboratory is not certified to perform the requested test."
TCTechnical Component
Use with diagnostic codes to report technical component services or procedures and includes the cost of equipment and supplies to perform that service or procedure. This modifier corresponds to the equipment/facility part of a given service or procedure. Report separate professional and technical component services only if different providers perform the professional and technical portions of the procedure.

Read CPT descriptors carefully. Do not use modifiers if the descriptor specifies professional or technical components.
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 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- payment or commercial insurance payments from the usual and customary charges.
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.
24H. EPSDT/Family PlanConditional

EPSDT (shaded area)
For Early and Periodic Screening, Diagnosis, and Treatment related services, enter the response in the shaded portion of the field as follows:

AVAvailable- Not Used
S2Under Treatment
STNew Service Requested
NUNot Used

Family Planning (unshaded area)
Not 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 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 PaidConditionalEnter the total amount paid by Medicare or any other commercial health insurance that has made payment on the billed services.

Do not use commas when reporting dollar amounts. Enter 00 in the cents area if the amount is a whole number.
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. Service Facility Location Information
32a- NPI Number
32b- Other ID #
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
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.

Back to Top

 

CMS 1500 Laboratory Services Claim Example with CLIA Number

CMS 1500 Laboratory Services Claim Example with CLIA Number

Back to Top

 

CMS 1500 Laboratory Services Crossover Claim Example with CLIA Number

CMS 1500 Laboratory Services Crossover Claim Example with CLIA Number

Back to Top

 

Timely Filing

Refer to the General Provider Information Manual for more information on timely filing policy, including the resubmission rules for denied claims.

Back to Top

 

Laboratory Services Revision Log

Revision DateSection/ActionMade by
12/01/2016Manual 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 Manuals 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
2/9/2018Removed NDC supplemental qualifier - not relevant for independent laboratory providersDXC
6/25/2018Updated general billing and timely to point to general manualHCPF
12/21/2018Clarification to signature requirementsHCPF
2/22/19Add Section on Drug Testing Unit Limitations and Documentation Requirements
Added term dates and new codes to PAR table
HCPF
3/18/2019Clarification to signature requirementsHCPF
5/6/19Add Section on Newborn Metabolic Screening
Update Title to Laboratory Services
HCPF
5/22/19Add Codes to Prior Authorization TableHCPF
9/16/19Updated Drug Limitations sectionHCPF
12/27/19Converted to web pageHCPF
1/10/2020Added BRCA/Prenatal section, added codes to PAR tableHCPF
1/14/2020Update Drug Limitations sectionHCPF
9/10/2020Added Line to Box 32 under the CMS 1500 Paper Claim Reference TableHCPF
8/2/2021Updated to box 17 of CMS 1500 Claims ExampleHCPF
8/2/2021Update to Drug Testing Unit Limitations and Documentation RequirementsHCPF
8/31/2021
  • Created OPR section 
  • Amended Box 17 of CMS 1500 Claims Example
  • Clarified language under Handling, Collection and Conveyance Charges section
  • Clarified language under General Requirements section
HCPF
8/1/2022•    Updated ordering, prescribing, referring policy 
•    Updated prenatal testing policy to align with changed policy in rule 10 CCR 2505-10 8.732
•    Added unlisted procedure code section.
 
HCPF
10/14/2022Removed Phone Number to Gainwell Technologies. Linked verbiage to Provider Help web page.    HCPF
8/2/2023Removed CPT 81220 as requiring a PARHCPF