Peer Services

Colorado is reforming its behavioral health system. This transformation is vital to make sure every Coloradan can access the behavioral health care they need when they need it. The Department of Health Care Policy and Financing is working to expand the spectrum of behavioral health services for Health First Colorado (Colorado’s Medicaid program) members. This includes access to behavioral health peer services for members. These services are supportive and skill-building activities delivered by Behavioral Health Peer Support Professionals. 

Behavioral Health Peer Support Professionals (Peers) are individuals who are trained to use their lived experience with a behavioral health disorder to help others. Peers are an addition to the member’s care team. They can offer practical solutions and focused problem solving to help members practice building skills needed to maintain their health and wellbeing.

HCPF, in partnership with the Behavioral Health Administration (BHA), created a new provider type, Recovery Support Services Organization (RSSO), to allow for an additional path to bill for recovery-oriented Peer Services. 

In response to budget adjustments authorized by the state legislature, effective July 1, 2025, HCPF limited the codes that can be billed for individual contributions by Behavioral Health Peer Support Professionals. For detailed information, please visit the Behavioral Health Peer Support Policy webpage.

In alignment with the Medicaid Sustainability Memo published in June 2025, HCPF is implementing the following policy for Peer Support Professionals delivering behavioral health services billable to a Regional Accountable Entity (RAE) (henceforth referred to as Behavioral Health Peer Support Professionals).

Effective January 1, 2026, all Behavioral Health Peer Support Professionals must either be certified or be in the process of becoming certified in order for the services they deliver to be reimbursable by a Health First Colorado Regional Accountable Entity (RAE).

In the process of becoming certified is defined as: Peers who have completed all 60 hours of required training and are in the process of completing their hours of experience and working towards certification. Services delivered by Behavioral Health Peer Support Professionals in the process of becoming certified are reimbursable for up to 6 months following the completion of required training.

Agencies must sign and submit this attestation to their RAE or RAEs by January 1 annually, indicating that all Behavioral Health Peer Support Professionals delivering services to Medicaid members are either certified or are in the process of becoming certified.

Frequently Asked Questions

• Are Peer Support services billable?
• How are Peer Services reimbursed by Medicaid? Can Peer Support Professionals submit claims to Medicaid?
• Is transportation a reimbursable activity?
• Where can I find more information and updates about reimbursement for Peer Support services?
• Do Peers delivering Medicaid billable services need to have a certification?
• What are the requirements regarding oversight of Behavioral Health Peer Support Professionals?
• What is the difference between Rendering Provider Oversight (RPO) and other types of supervision?
• Does my agency need to obtain a license from the BHA?
• How does my agency become a Recovery Support Services Organization (RSSO provider type 89/889) and bill Health First Colorado for services?
• Is it permitted to use a self-reported diagnosis from the client or a diagnosis reported by another provider?
• Who do I contact for help with billing and coding questions?

Are Peer services billable?

• Effective July 1, 2025, HCPF limited the codes that can be billed for individual contributions by Peer Support Professionals to the following:
  • H0038: Self-help/Peer Services
  • H0023: Behavioral Health Outreach Service
• Behavioral Health Peer Support Professionals may deliver services within their scope as part of a multidisciplinary team for individuals with behavioral health needs. As part of a multidisciplinary team, Peers may participate in the delivery of team-based services. For a comprehensive list of codes Peers can deliver as part of a multidisciplinary team, please refer the Peer Support Policy webpage.

How are Peer Services reimbursed by Medicaid? Can Peer Support Professionals submit claims to Medicaid?

• Peer Support services are reimbursed through the Capitated Behavioral Health Benefit as outpatient behavioral health services. HCPF provides a set amount to RAEs to cover provision of all behavioral health services provided under the Capitation. RAEs are responsible to determine, based on member needs in the region, how best to spend the money, considering factors such as number of members using particular services and number of providers available. As part of contracting, RAEs negotiate rates with each provider. Providers negotiate and set contracts with the RAE(s) and then are able to bill for Peer Support services.
• Peer Support Professionals cannot directly submit claims for the services they deliver. Only a provider enrolled with Medicaid can submit a claim to their RAE for behavioral health services. Behavioral health services delivered by a Peer Support Professional must be billed under the National Provider Identification (NPI) number of the Rendering Provider responsible for oversight.

Is transportation a reimbursable activity?

Code H0038 does cover transportation of professionals serving Health First Colorado members in circumstances where the delivery provider is traveling with the member in context of a skill building or coping skill building task. As an example, riding with a member on a bus line to help them learn a transit system or become comfortable with using the bus to get groceries would be a covered service. In these cases, the time spent in travel is part of the skill building activity and would be counted as part of the visit.

Where can I find more information and updates about reimbursement for Peer Support services?

Visit HCPF’s Behavioral Health Policies, Standards, and Billing References webpage and navigate to the Behavioral Health Peer Support Policy section to learn more.

Do Peers delivering Medicaid billable services need to have a certification?

The SMD letter #07-011 indicates that states must determine the minimum training and certification criteria for professionals delivering peer support services in a behavioral health context. HCPF follows the definitions of training and certification requirements for Peer Support Professionals in Behavioral Health Administration (BHA) rule. In alignment with the Medicaid Sustainability Memo published in June 2025, HCPF is implementing the following policy for Peer Support Professionals delivering behavioral health services billable to a Regional Accountable Entity (RAE) (henceforth referred to as Behavioral Health Peer Support Professionals).

Effective January 1, 2026, all Behavioral Health Peer Support Professionals must either be certified or be in the process of becoming certified in order for the services they deliver to be reimbursable by a Health First Colorado Regional Accountable Entity (RAE). 

In the process of becoming certified is defined as: Peers who have completed all 60 hours of required training and are in the process of completing their hours of experience and working towards certification. Services delivered by Behavioral Health Peer Support Professionals in the process of becoming certified are reimbursable for up to 6 months following the completion of required training.

Agencies must sign and submit this attestation to their Regional Accountable Entity (RAE) or RAEs by January 1st annually, indicating that all Behavioral Health Peer Support Professionals are either certified or are in the process of becoming certified.

What are the requirements regarding oversight of Behavioral Health Peer Support Professionals?

• Under federal Medicaid policies, unlicensed professionals (including Behavioral Health Peer Support Professionals) are not able to independently deliver Medicaid reimbursable behavioral health services because they do not hold a valid active license in Colorado. In order to reimburse for care delivered by these individuals, their services must be billed under a Rendering Provider.
• For more information, visit the Health First Colorado Behavioral Health Rendering Provider Oversight (RPO) Policy section of the BH policies webpage. 

What is the difference between Rendering Provider Oversight (RPO) and other types of supervision?

• The Rendering Provider is the licensed clinician who is responsible for ensuring that the services being delivered are medically necessary.  They review the treatment plan goals and progress of the member receiving services, identify any new setbacks, and provide  oversight of behavioral health services delivered by the Peer Support Professional.
• Agencies can choose to encourage or require other types of supervision, in addition to the requirement of Rendering Provider Oversight (RPO), depending on the needs of the professional. For example, a Peer Support Professional may also receive support with HR-related tasks from an Employment Supervisor, as well as mentorship from an experienced Peer Support Professional. These other types of professionals may be responsible for setting employee goals and reviews, giving job feedback, completing all HR-related tasks, as well as holding regular check-ins, evaluating work load, problem-solving strategies and providing moral support. However, they do not replace the role of a Rendering Provider who ensures Medicaid billable behavioral health services are delivered to members in accordance with all Medicaid rules and requirements.

Does my agency need to obtain a license from the BHA?

• In order to enroll with Medicaid as a Recovery Support Services Organizations (RSSO), an agency must first obtain an RSSO designation from the BHA.
• Clinical behavioral health providers who employ 9 or more licensed clinicians, as well as  agencies who deliver SUD services are required to obtain a Behavioral Health Entity (BHE) license through the BHA.
• Please visit the BHA’s Behavioral Health Designation and Licensing page to find more information on what is required.

How does my agency become a Recovery Support Services Organization (RSSO provider type 89/889) and bill Health First Colorado for services?

• Outreach the RAE(s) your agency is interested in contracting with to determine if there are network needs for the type of services you provide.
• Obtain an RSSO designation from BHA.
• Enroll with HCPF.
• Contract with a Regional Accountable Entity for behavioral health services outlined in the State Behavioral Health Billing Manual.

Is it permitted to use a self-reported diagnosis from the client or a diagnosis reported by another provider?

Yes, when newly engaging a client in Peer Services, agencies may obtain a member’s diagnosis from another provider through a Release of Information (ROI), if applicable. If the member does not yet have an official diagnosis, it is permissible to use ‘deferred diagnosis’ on the claim form.
 

Who do I contact for help with billing and coding questions?

Please reach out to your Regional Accountable Entity (RAE) or you can contact HCPF for questions about the State Behavioral Health Services Billing Manual at hcpf_bhcoding@state.co.us

Peer Resources

• State Behavioral Health Services Billing Manual
• Behavioral Health Policies, Standards, and Billing References
• Behavioral Health Peer Support Policy
• Provider Enrollment Page
• Find Your Provider Type Page
• Provider Portal
• Provider Contacts
• Investing in the Peer Support Workforce (2023)

Stay Informed

To ask a question or make a suggestion contact us by email: hcpf_peerservices@state.co.us