- Health First Colorado School Health Services
- School Health Services Program Manual
- Prior Authorization Requirements
- Procedure Codes/Billing Requirements
- Acronyms
- Paper Claim Reference Table
- Health First Colorado School Health Services Revision Log
Return to Billing Manuals Web Page
Health First Colorado School Health Services
The Colorado School Health Services (SHS) Program allows school districts and Boards of Cooperative Education Services (BOCES) to access federal Health First Colorado funds for delivering Health First Colorado allowable school health services to Health First Colorado enrolled children. Reimbursement received by a district through the SHS Program shall be used by the district to provide additional and expanded health services.
This billing manual is for employees and contractors of school districts and BOCES who are billing through the SHS Program. Community providers who have approval from the school district or BOCES and are providing services in a school setting but are not billing through the SHS Program should refer to the billing manual for the benefit they are billing.
School Health Services Program Manual
For an in-depth look at the policy requirements of the School Health Services Program refer to the School Health Services Program web page for more information. The manual includes information on covered services, provider enrollment, random moment time study, reimbursement and administrative claiming.
Prior Authorization Requirements
There are no prior authorization requirements for School Health Services.
Procedure Codes/Billing Requirements
The School Health Services Program uses 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 School Health Service Providers - provider type 51. Claims for all Health First Colorado-allowable school health services must be submitted within 120 days of the date of service.
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. Valid codes and descriptions for the School Health Services Program are listed below.
Effective for dates of service starting July 1, 2024, for Physical Therapy, Occupational Therapy, and Speech, Language, and Hearing Services claims must contain a valid National Provider Identifier (NPI) of the Ordering, Prescribing and Referring (OPR) Provider in accordance with 42 CFR 455.440. The individual provider must have their NPI listed as the ordering NPI for medically necessary services documented in an Individualized Education Program (IEP), an Individualized Family Service Plan (IFSP) or other medical plan(s) of care.
Note: Common Procedural Terminology (CPT) code descriptions are not contained in this manual. The descriptions are copyrighted by the American Medical Association (AMA). Providers should reference the 2023 CPT coding manuals for procedure code descriptions.
| PROCEDURE CODE | PROCEDURE CODE DESCRIPTIONS | MODIFIER | |
|---|---|---|---|
| 1 | 2 | ||
| Behavioral Health Services | |||
| 90785 | Interactive complexity add-on | ||
| 90832 | Psychotherapy with member, 30 minutes | ||
| 90834 | Psychotherapy with member, 45 minutes | ||
| 90837 | Psychotherapy with member, 60 minutes | ||
| 90839 | first 60 minutes | ||
| 90840 | each additional 30 minutes (list separately in addition to code for primary service) | ||
| 90846 | Family psychotherapy without member present | ||
| 90847 | Family psychotherapy with member present | ||
| 90849 | Multiple-family group psychotherapy | ||
| 90853 | Group psychotherapy | ||
| 90875 | Individual psychophysiological therapy incorporating biofeedback with psychotherapy, 30 minutes | ||
| 90876 | Individual psychophysiological therapy incorporating biofeedback with psychotherapy, 45 minutes | ||
| 96156 | LPC/LMFT (effective 1/1/2020) | ||
| 96156 | PSY (effective 1/1/2020) | AH | |
| 96156 | SW (effective 1/1/2020) | AJ | |
| 96156 | Re-Assessment - LPC/LMFT (effective 1/1/2020) | ||
| 96156 | Re-Assessment - PSY (effective 1/1/2020) | AH | |
| 96156 | Re-Assessment - SW (effective 1/1/2020) | AJ | |
| 97153 | each 15 minutes | ||
| 97153 | Telehealth (each 15 minutes) | GT | |
| 97154 | each 15 minutes | ||
| 97154 | Telehealth (each 15 minutes) | GT | |
| 97155 | each 15 minutes | ||
| 97155 | Telehealth (each 15 minutes) | GT | |
| 97158 | each 15 minutes | ||
| 97158 | Telehealth (each 15 minutes) | GT | |
| 97151 | Per Assessment Once Per Year | ||
| 97151 | Telehealth (Per Assessment Once Per Year) | GT | |
| 97151 | Re-assessment (limited to 2 units per six months) | TJ | |
| 97151 | Re-assessment (limited to 2 units per six months), Telehealth | TJ | GT |
| H0004 | Behavioral Health Counseling/Therapy Alcohol/Drug -LPC/LMFT (per 15 minutes) | ||
| H0004 | Behavioral Health Counseling/Therapy Alcohol/Drug, Telehealth -LPC/LMFT (per 15 minutes) | GT | |
| H0004 | Behavioral Health Counseling/Therapy Alcohol/Drug - PSY (per 15 minutes) | AH | |
| H0004 | Behavioral Health Counseling/Therapy Alcohol/Drug - PSY (per 15 minutes), Telehealth | AH | GT |
| H0004 | Behavioral Health Counseling/Therapy Alcohol/Drug - SW (per 15 minutes) | AJ | |
| H0004 | Behavioral Health Counseling/Therapy Alcohol/Drug - SW (per 15 minutes), Telehealth | AJ | GT |
| H0004 | Behavioral Health Counseling/Therapy Alcohol/Drug, Group - LPC /LMFT (per 15 minutes) | HQ | |
| H0004 | Behavioral Health Counseling/Therapy Alcohol/Drug, Group - LPC /LMFT (per 15 minutes), Telehealth | HQ | GT |
| H0004 | Behavioral Health Counseling/Therapy Alcohol/Drug, Group - PSY (per 15 minutes) | AH | HQ |
| H0004 | Behavioral Health Counseling/Therapy Alcohol/Drug, Group - PSY (per 15 minutes), Telehealth | AH/HQ | GT |
| H0004 | Behavioral Health Counseling/Therapy Alcohol/Drug, Group - SW (per 15 minutes) | AJ | HQ |
| H0004 | Behavioral Health Counseling/Therapy Alcohol/Drug, Group, - SW (per 15 minutes), Telehealth | AJ/HQ | GT |
| H0005 | Alcohol and/or drug services, group counseling | ||
| H0038 | Self-help/peer services, per 15 minutes | ||
| H2014 | Skills training and development, per 15 minutes | ||
| H2017 | Psychosocial rehabilitation services, per 15 minutes | ||
| H2023 | Supported employment, per 15 minutes | ||
| H2027 | Psychoeducational service | ||
| S9445 | Member education, not otherwise classified, non-physician provider, individual | ||
| Motor Therapy Services | |||
| 97161 | 1 unit per evaluation up to 20 minutes | ||
| 97161 | Telehealth (1 unit per evaluation up to 20 minutes | GT | |
| 97162 | 1 unit per evaluation up to 30 minutes | ||
| 97162 | Telehealth (1 unit per evaluation up to 30 minutes) | GT | |
| 97163 | 1 unit per evaluation up to 45 minutes | ||
| 97163 | Telehealth (1 unit per evaluation up to 45 minutes) | GT | |
| 97164 | Re-Evaluation (1 unit per evaluation typically up to 20 minutes) | ||
| 97164 | Re-Evaluation, Telehealth (1 unit per evaluation typically up to 20 minutes) | GT | |
| 97110 | PTA (each 15 minutes) | HM | |
| 97110 | PTA (each 15 minutes), Telehealth | HM | GT |
| 97150 | PT (each 15 minutes) | GP | |
| 97150 | PT (each 15 minutes), Telehealth | GP | GT |
| 97150 | PTA (each 15 minutes) | HM | |
| 97150 | PTA (each 15 minutes), Telehealth | HM | GT |
| 97165 | 1 unit per evaluation up to 30 minutes | ||
| 97165 | Telehealth (1 unit per evaluation up to 30 minutes) | GT | |
| 97166 | 1 unit per evaluation up to 45 minutes | ||
| 97166 | Telehealth (1 unit per evaluation up to 45 minutes) | GT | |
| 97167 | 1 unit per evaluation up to 60 minutes | ||
| 97167 | Telehealth (1 unit per evaluation up to 60 minutes) | GT | |
| 97168 | Re-Evaluation (1 unit per evaluation typically up to 30 minutes) | ||
| 97168 | Re-Evaluation, Telehealth (1 unit per evaluation typically up to 30 minutes) | GT | |
| 97530 | each 15 minutes | GO | |
| 97530 | each 15 minutes, Telehealth | GO | GT |
| 97530 | COTA (each 15 minutes) | HM | |
| 97530 | COTA (each 15 minutes), Telehealth | HM | GT |
| 97139 | OT (each 15 minutes) | GO | |
| 97139 | COTA (each 15 minutes) | HM | |
| 97139 | OT/COTA (each 15 minutes) Telehealth | HM | GT |
| 97116 | each 15 minutes | ||
| 97116 | O & M (each 15 minutes) | HQ | |
| 97533 | each 15 minutes | ||
| 97533 | Telehealth (each 15 minutes) | GT | |
| 97533 | O & M (each 15 minutes) | HQ | |
| Nursing Services | |||
| T1001 | Nursing Assessment/Evaluation (RN only) | ||
| T1001 | Nursing Assessment/Evaluation RN/NP only (up to 15 minutes) | ||
| T1002 | RN/NP Services, (up to 15 minutes) | ||
| T1002 | RN/NP Services, Group, (up to 15 minutes) | HQ | |
| T1003 | LPN Services, (up to 15 minutes) (delegated RN/NP service) | ||
| T1003 | LPN Services, Group, (up to 15 minutes) (delegated RN/NP service) | HQ | |
| T1004 | Qualified Nursing Aide/Health Technician, (up to 15 minutes) (delegated RN/NP service) | ||
| T1004 | Qualified Nursing Aide/Health Technician, Group, (up to 15 minutes) (delegated RN/NP service) | HQ | |
| 99201 | NP (10 minutes) | ||
| 99201 | Telehealth - NP (10 minutes) | GT | |
| 99202 | NP (20 minutes - expanded) | ||
| 99202 | Telehealth - NP (20 minutes - expanded) | GT | |
| 99203 | NP (30 minutes - detailed) | ||
| 99203 | Telehealth - NP (30 minutes - detailed) | GT | |
| 99204 | NP (45 minutes comprehensive) | ||
| 99204 | Telehealth - NP (45 minutes comprehensive) | GT | |
| 99205 | NP(60 minutes high complexity) | ||
| 99205 | Telehealth - NP (60 minutes high complexity) | GT | |
| 99212 | NP (10 minutes straightforward) | ||
| 99212 | Telehealth - NP (10 minutes straightforward) | GT | |
| 99213 | NP (15 minutes low complexity) | ||
| 99213 | Telehealth - NP (15 minutes low complexity) | GT | |
| 99214 | NP (25 minutes moderate complexity) | ||
| 99214 | Telehealth - NP (25 minutes moderate complexity) | GT | |
| 99215 | NP (40 minutes high complexity) | ||
| 99215 | Telehealth - NP (40 minutes high complexity) | GT | |
| Personal Care Services | |||
| T1019 | Personal Care Services, Individual (per 15 minutes) | ||
| S5125 | Personal Care Services, Group (per 15 min) - Safety/Behavior Monitoring Only | ||
| Physician Services | |||
| 90839 | first 60 minutes | ||
| 90840 | each additional 30 minutes (list separately in addition to code for primary service) | ||
| 99201 | MD/DO (10 minutes) | ||
| 99201 | MD/DO (10 minutes), Telehealth | GT | |
| 99202 | MD/DO (20 minutes - expanded) | ||
| 99202 | MD/DO (20 minutes - expanded), Telehealth | GT | |
| 99203 | MD-DO (30 minutes - detailed) | ||
| 99203 | MD-DO (30 minutes - detailed), Telehealth | GT | |
| 99204 | MD/DO (45 minutes - comprehensive) | ||
| 99204 | MD/DO (45 minutes - comprehensive), Telehealth | GT | |
| 99205 | MD/DO (60 minutes - high complexity) | ||
| 99205 | MD/DO (60 minutes - high complexity), Telehealth | GT | |
| 99212 | MD/DO (10 minutes - straightforward) | ||
| 99212 | MD/DO (10 minutes - straightforward), Telehealth | GT | |
| 99213 | MD/DO (15 minutes - low complexity) | ||
| 99213 | MD/DO (15 minutes - low complexity), Telehealth | GT | |
| 99214 | MD/DO (25 minutes - moderate complexity) | ||
| 99214 | MD/DO (25 minutes - moderate complexity), Telehealth | GT | |
| 99215 | MD/DO (40 minutes - high complexity) | ||
| 99215 | MD/DO (40 minutes - high complexity), Telehealth | GT | |
| Speech and Audiology Services | |||
| 92507 | 1 unit per session | ||
| 92507 | Telehealth (1 unit per session) | GT | |
| 92508 | 1 unit per session | ||
| 92508 (GT) | Telehealth, Group (1 unit per session) | GT | |
| 92521 | GN | ||
| 92521 | Telehealth | GT | |
| 92522 | GN | ||
| 92522 | Telehealth | GT | |
| 92523 | GN | ||
| 92523 | Telehealth | GT | |
| 92524 | GN | ||
| 92524 | Telehealth | GT | |
| V5008 | 1 unit per evaluation - Audiologist only | ||
| V5299 | each 15 minutes) | ||
| V5299 | Group | HQ | |
| Transportation Services | |||
| T2001 | Non-Emergency Transportation - Member Attendant/Escort/Aide (per 15 minutes) | ||
| T2001 | Non-Emergency Transportation, Group - Member Attendant/Escort/Aide (per 15 minutes) | HQ | |
| T2003 | Non-Emergency Transportation - Trip Encounter (per one-way trip) | ||
Acronyms
COTA -Certified Occupational Therapy Assistant
DO - Doctor of Osteopathic Medicine
LMFT - Licensed Marriage & Family Therapist
LPC - Licensed Practical Counselor
LPN - Licensed Practical Nurse
MD - Medical Doctor
NP - Nurse Practitioner
OT - Occupational Therapist
PSY - Psychologist
PT - Physical Therapist
PTA - Physical Therapy Assistant
RN - Registered Nurse
SLP - Speech Language Pathologist
SW - Social Worker
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.
School Health Services claims shall be billed as a single date of service, using the specific date a service is provided. Use number of units to identify repeated services by the same provider, on the same date.
| CMS Field Number & 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 seven-digit Health First Colorado 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 | Conditional | Complete 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 Address | Not Required | |||||||||||||||||||||||||||||||||||||
| 6. Patient's Relationship to Insured | Conditional | Complete if the member is covered by a commercial health care insurance policy. | ||||||||||||||||||||||||||||||||||||
| 7. Insured's Address | Not Required | |||||||||||||||||||||||||||||||||||||
| 8. Reserved for NUCC Use | Not Required | |||||||||||||||||||||||||||||||||||||
| 9. Other Insured's Name | Conditional | If field 11d is marked "YES", enter the insured's last name, first name and middle initial. | ||||||||||||||||||||||||||||||||||||
| 9a. Other Insured's Policy or Group Number | Conditional | If 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 Name | Not Required | |||||||||||||||||||||||||||||||||||||
| 10a-c. Is patient's condition related to? | Conditional | When 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 Number | Conditional | Complete 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, Sex | Conditional | Complete 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: 070118 for July 1, 2018. Place an "X" in the appropriate box to indicate the sex of the insured. | ||||||||||||||||||||||||||||||||||||
| 11b. Other Claim ID | Not Required | |||||||||||||||||||||||||||||||||||||
| 11c. Insurance Plan Name or Program Name | Not Required | |||||||||||||||||||||||||||||||||||||
| 11d. Is there another Health Benefit Plan? | Conditional | When appropriate, place an "X" in the correct box. If marked "YES", complete 9, 9a and 9d. | ||||||||||||||||||||||||||||||||||||
| 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 | Complete 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 | Not Required | |||||||||||||||||||||||||||||||||||||
| 16. Date Patient Unable to Work in Current Occupation | Not Required | |||||||||||||||||||||||||||||||||||||
| 17. Name of Referring Physician | Conditional | Complete with District/BOCES NPI number for claims with a date of service on or after January 1, 2022, for any of the following services:
| ||||||||||||||||||||||||||||||||||||
| 18. Hospitalization Dates Related to Current Service | Conditional | Complete 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: 070118 for July 1, 2018. If the member is still hospitalized, the discharge date may be omitted. This information is not edited. | ||||||||||||||||||||||||||||||||||||
| 19. Additional Claim Information | Conditional | |||||||||||||||||||||||||||||||||||||
| 20. Outside Lab? $ Charges | Conditional | Complete 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 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. | ||||||||||||||||||||||||||||||||||||
| 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 | Conditional | CLIA 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 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. The Health First Colorado accepts the CMS place of service codes. | ||||||||||||||||||||||||||||||||||||
| 24C. EMG | Conditional | Enter 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 Supplies | Required | Enter 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. 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. | ||||||||||||||||||||||||||||||||||||
| 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 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. Codes that define units as inclusive numbers Some services such as allergy testing define units by the number of services as an inclusive number, not as additional services. | ||||||||||||||||||||||||||||||||||||
| 24H. EPSDT/Family Plan | Conditional | EPSDT (shaded area)
Family Planning (unshaded area) | ||||||||||||||||||||||||||||||||||||
| 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 | Conditional | Enter 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 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 # | Required | 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. | |||||||||||||||||||||||||||||||||||||
School Health Services Revisions Log
| Revision Date | Addition/Changes | Made by |
|---|---|---|
| 8/2/2018 | Creation of separate School Health Services Manual | HCPF |
| 2/19/2020 | Replaced procedure codes 96150 and 96151 with one code 96156 effective 1/1/2020 | HCPF |
| 2/26/2020 | Updated claim reference table layout | HCPF |
| 2/27/2020 | Converted to web page | HCPF |
| 9/14/2020 | Added Line to Box 32 under the CMS 1500 Paper Claim Reference Table | HCPF |
| 9/28/2020 | Added procedure codes for new qualified provider types and removed Target Case Management category | HCPF |
| 12/21/2020 | Added telemedicine modifier code GT to procedure code 97139 | HCPF |
| 11/15/2021 | Added Ordering, Referring, and Prescribing (ORP) Provider Requirements | HCPF |
| 08/23/2022 | Added procedure codes 90839 and 90840 | HCPF |
| 09/26/2023 | Updated language around 120 day timely filing | HCPF |
| 07/01/2024 | NPI OPR requirement changed to individual provider, included language on community providers billing in a school setting, and added behavioral health procedure codes required by SB 23-174. | HCPF |