Colorado

Last updated 08/14/2024

Consent Requirements

A health-care or mental health-care provider who delivers health-care or mental health-care services through telemedicine shall provide to each patient, before treating that patient through telemedicine for the first time, the following written statements:

• The patient may refuse telemedicine services at any time without affecting the patient’s right to future care or treatment and without risking the loss or withdrawal of any program benefits to which the patient would otherwise be entitled;
• All applicable confidentiality protections shall apply to the services;
• The patient shall have access to all medical information resulting from the services, under state law.

This subsection shall not apply in an emergency.

SOURCE: CO Revised Statutes 25.5-5-320. (Accessed Aug. 2024).

For initial visits, providers must comply with the requirements posted under Waiving the Face-to-Face Requirement & Required Disclosure Statements. For each subsequent visit, providers must document the member’s consent, either verbal or written, to receive telemedicine services.

Waiving the Face-to-Face Requirement & Required Disclosure Statements

The Health First Colorado requirement for an initial face-to-face contact between provider and member may be waived when treating the member through telemedicine. In-person contact between a health care provider and a member is not required for services delivered through telemedicine that are otherwise eligible for reimbursement.

Prior to treating the member through telemedicine for the first time, the provider must furnish each member with all of the following written statements, which must be signed (electronic signatures will be accepted) by the member or the member’s legal representative:

• The member retains the option to refuse the delivery of health care services via telemedicine at any time without affecting the member’s right to future care or treatment and without risking the loss or withdrawal of any program benefits to which the member would otherwise be entitled.
• All applicable confidentiality protections shall apply to the services.
• The members shall have access to all medical information resulting from the telemedicine services as provided by applicable law for member access to his or her medical records. [C. R. S. 2018, 25.5-5-320 (4)].

These requirements do not apply in an emergency. [C. R. S. 2018, 25.5-5-320 (5)].

SOURCE: CO Department of Health Care Policy and Financing.  “Telemedicine Billing Manual” 5/24. (Accessed Aug. 2024).

Covered telemedicine services must be provided only after the member’s consent, either verbal or written, to receive telemedicine services is documented.

SOURCE: CO Adopted Rule 8.095.4.A. (Accessed Aug. 2024).

All consent for telemedicine services could be verbal during the PHE. Providers must obtain written consent prior to the first visit post-PHE, as described in the Waiving the Face-to-Face Requirement & Required Disclosure Statements section of the Telemedicine Billing Manual.

Last updated 08/12/2024

Definitions

Telemedicine means the delivery of medical and health-care services and any diagnosis, consultation, or treatment using interactive audio (including but not limited to telephone and relay calls), interactive video (including but not limited to interactive audiovisual modalities), or interactive data communication (including but not limited to live chat and excluding text messaging, electronic mail, and facsimile transmission).

SOURCE: Colorado Adopted Rule 8.095.1.A. (Accessed Aug. 2024).

Telemedicine is not a unique service, but a means of providing services approved by Health First Colorado through live interactive audio and video telecommunications equipment.

SOURCE: CO Department of Health Care Policy and Financing. “Telemedicine Billing Manual.” (Accessed Aug. 2024).

“Telemedicine” means the delivery of medical and health-care services and any diagnosis, consultation, or treatment using interactive audio, interactive video, or interactive data communication.

SOURCE: Colorado Revised Statute 25.5.-4-103 (25.7) (Accessed Aug. 2024).

Telehealth remote monitoring services include the installation and on-going remote monitoring of clinical data through technologic equipment in order to detect minute changes in the client’s clinical status that will allow Home Health agencies to intercede before a chronic illness exacerbates requiring emergency intervention or inpatient hospitalization.

SOURCE: CO Medical Assistance Program, Home Health Billing Manual, (7/24), (Accessed Aug. 2024). 

Telehealth allows for the monitoring of a member’s health status remotely via equipment, which transmits data from the member’s home to the member’s home health agency. The purpose of providing telehealth services is to assist in the effective management and monitoring of members whose medical needs can be appropriately and cost-effectively met at home through the frequent monitoring of data and early intervention.

Telemedicine is the term used when a medical provider sees a member through the use of internet connections. This technology is typically used when a member needs to see a medical specialist, but there are no acceptable specialists in the member’s service area. Telehealth is the monitoring of member’s vital signs by their Home Health nurse through electronic submission of the vital sign information from the member’s residence to the member’s Home Health Agency.

SOURCE: CO Department of Health Care Policy and Financing. “Home Health Telehealth”. (Accessed Aug. 2024).

Home and Community-Based Services (HCBS)

Telehealth means the broad use of technologies to provide services and supports through HCBS waivers, when the Member is in a different location from the provider.

SOURCE: Colorado Adopted Rule 8.615.1 (M). (Accessed Aug. 2024).

Telehealth means the provision of health care remotely using telecommunications technologies to provide approved services and supports through HCBS waivers when the Member is in a different location from the provider.

SOURCE: 10 CCR 2505-10, Section 8.7402. (Accessed Aug. 2024).

Early Childhood Intervention Program

Telehealth means a method of service provision that utilizes secure interactive videoconferencing to deliver early intervention services.

SOURCE: 8 CCR 1405-1, Section 5.103. (Accessed Aug. 2024).

Behavioral Health

“Telehealth” means delivery of services through telecommunications systems that are compliant with all federal and state protections of individual privacy, to facilitate individual assessment, diagnosis, consultation, treatment, and/or service planning/case management when the individual and the person providing services are not in the same physical location. Telecommunications systems used to provide telehealth include information, electronic, and communication technologies. Telehealth may include audio-only methods in accordance with state and federal regulation unless noted otherwise.

SOURCE: 2 CO Code of Regulation 502-1, 1.2, p. 18. (Accessed Aug. 2024).

Program of All-Inclusive Care for the Elderly (PACE)

Telehealth means a mode of delivery of health care services through HIPAA-compliant telecommunications systems, including information, electronic, and communication technologies, remote monitoring technologies and store-and-forward transfers, to facilitate the assessment, diagnosis, consultation, treatment, education, care management, or self-management of a covered person’s health care while the covered person is located at an originating site and the provider is located at a distant site.

SOURCE: 10 CCR 2505-10, Section 8.497. (Accessed Aug. 2024).

Last updated 08/13/2024

Email, Phone & Fax

Telemedicine may be provided through interactive audio, interactive video, or interactive data communication, including but not limited to telephone, relay calls, interactive audiovisual modalities, and live chat as long as the technologies are compliant with HIPAA.  The health care or mental health care services are subject to reimbursement policies developed pursuant to the medical assistance program. Reimbursement rate must be, at minimum, the same as a comparable in-person services.

SOURCE: CO Revised Statutes 25.5-5-320. (Accessed Aug. 2024).

No reimbursement for provider-to-provider consultations provided by telephone (interactive audio), email or facsimile machines.

All rendering providers must bill the appropriate procedure code using Place of Service code 02 or 10 and the appropriate modifiers FQ or FR on the CMS 1500 paper claim form or as an 837P transaction.

Modifiers FQ, FR, 93, and 95 can be added to POS 02 and 10:

• FQ: The service was furnished using audio-only communication technology.
• FR: The supervising practitioner was present through two-way, audio/video communication technology.
• 93: Synchronous Telemedicine Service Rendered Via Telephone or Other Real-Time Interactive Audio-Only Telecommunications System
• 95: Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System

FQHCs/RHCs/IHS

Health First Colorado allows telemedicine visits to qualify as billable encounters for Federally Qualified Health Centers (FQHCs), Rural Health Clinic (RHCs), and Indian Health Services (IHS). Services allowed under telemedicine may be provided via telephone, live chat, or interactive audiovisual modality for these provider types.

Physical Therapy, Occupational Therapy, Home Health, Hospice and Pediatric Behavioral Health Providers

Physical therapists, occupational therapists, hospice, home health providers and pediatric behavioral health providers are eligible to deliver telemedicine services.

1. Home Health Agency services and therapies, Hospice, and Pediatric Behavioral Treatment may be provided via telephone-only.
2. Outpatient Physical, Occupational, and Speech Therapy services must have an interactive audio/visual connection with the member to be provided via telemedicine.

SOURCE: CO Department of Health Care Policy and Financing. “Telemedicine Billing Manual” 5/24. (Accessed Aug. 2024).

Behavioral Health

“Telehealth” means delivery of services through telecommunications systems that are compliant with all federal and state protections of individual privacy, to facilitate individual assessment, diagnosis, consultation, treatment, and/or service planning/case management when the individual and the person providing services are not in the same physical location. Telecommunications systems used to provide telehealth include information, electronic, and communication technologies. Telehealth may include audio-only methods in accordance with state and federal regulation unless noted otherwise.

“Session” means a face-to-face, telehealth, or audio-only interaction of the individual and personnel. Session may include but is not limited to individual therapy, group therapy, medication-assisted treatment education and/or monitoring, family therapy, peer professional services, educational/occupational groups, recreational therapy, intake, discharge, service planning, and other therapies.

Services may be provided through synchronous audio-visual methods but must not include text-only methods such as text message or email. Some services may be provided through audio-only methods according to state and federal regulations. If audio-only methods are used, the following must be noted in the individual record:

• The reason that audio-visual methods were not utilized.
• The clinical determination of appropriateness for service delivery method.

Screenings should be conducted in-person unless contraindicated. If contraindicated, screenings may be conducted via audio-visual or audio only telehealth. Clinical rationale must be documented in the case of a telehealth screening.

A peer support professional may provide services in a variety of settings, if permitted access, that may include but are not limited to audio-visual or audio-only telehealth.

Outpatient services may be delivered via in-person, audio-visual telehealth, or audio-only telehealth format in accordance with part 2.9 of these rules.

For purposes of Criminal Justice-Involved Individuals, services do not include consistent and regular in-session use of audio-only telehealth.

“Face-to-Face clinical assessment” means a formal and continuous process of collecting and evaluating information about an individual for service planning, treatment, referral, and funding eligibility as outlined in 21.190, and takes place at a minimum upon a request from the responsible person for funded services through the Children and Youth Mental Health Treatment Act. This information establishes justification for services and Children and Youth Mental Health Treatment Act funding. The child or youth must be physically in the same room as the professional person during the Face-to-Face clinical assessment. If the child is out of state or otherwise unable to participate in a Face- to-Face assessment, video technology may be used. If the Governor or local government declares an emergency or disaster, telephone may be used. Telephone shall only be used as necessary because of circumstances related to the disaster or emergency.

SOURCE: 2 CO Code of Regulation 502-1, 1.2, p. 18, 2.9, p. 40, 10.1, p. 174, 21.200.41, p. 357. (Accessed Aug. 2024).

Last updated 08/13/2024

Live Video

POLICY

CO Medicaid will cover medically necessary medical and surgical services furnished to eligible members.

Telemedicine services may be provided under two arrangements.

• The first arrangement is when a member receives services via a live audio/visual connection from a single provider. This is the predominant arrangement for telemedicine.
• The second arrangement is when a member and a provider are physically in the same location and additional services are provided by a second (distant) provider via a live audio/visual connection. In this arrangement the provider who is present with the member is called the “originating provider”, and the provider located at a different site, acting as a consultant, is called the “distant provider”.

The member must be present during any Telemedicine visit.

It is acceptable to use Telemedicine to facilitate live contact directly between a member and a provider.

SOURCE: CO Department of Health Care Policy and Financing.  “Telemedicine Billing Manual,” 5/24. (Accessed Aug. 2024).

In-person contact between a health care or mental health care provider and a patient is not required under the state’s medical assistance program for health care or mental health care services delivered through telemedicine that are otherwise eligible for reimbursement under the program. Any health care or mental health care service delivered through telemedicine must meet the same standard of care as an in-person visit. Telemedicine may be provided through interactive audio, interactive video, or interactive data communication, including but not limited to telephone, relay calls, interactive audiovisual modalities, and live chat as long as the technologies are compliant with HIPAA.  The health care or mental health care services are subject to reimbursement policies developed pursuant to the medical assistance program. This section also applies to managed care organizations that contract with the state department pursuant to the statewide managed care system only to the extent that:

• Health care or mental health care services delivered through telemedicine are covered by and reimbursed under the Medicaid per diem payment program; and
• Managed care contracts with managed care organizations are amended to add coverage of health care or mental health care services delivered through telemedicine and any appropriate per diem rate adjustments are incorporated.

The reimbursement rate for a telemedicine service shall, as a minimum, be set at the same rate as the medical assistance program rate for a comparable in-person service. The state department may consider setting the reimbursement rate on a monthly basis as well as on a daily or per-visit basis.

SOURCE: CO Revised Statutes 25.5-5-320. (Accessed Aug. 2024).

Interim Therapeutic Restorations

In-person contact between a health care provider and a member is not required under the state’s medical assistance program for the diagnosis, development of a treatment plan, instruction to perform an interim therapeutic restoration procedure, or supervision of a dental hygienist performing an interim therapeutic restoration procedure. A health care provider may provide these services through telehealth, including store-and-forward transfer, and is entitled to reimbursement for the delivery of those services via telehealth to the extent the services are otherwise eligible for reimbursement under the program when provided in person. The services are subject to the reimbursement policies developed pursuant to the state medical assistance program.

SOURCE: CO Revised Statutes 25.5-5-321.5 as proposed to be amended by SB 24-176 (2024 Session). (Accessed Aug. 2024).

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ELIGIBLE SERVICES/SPECIALTIES

Colorado Medicaid will reimburse for medical and mental health services delivered through telemedicine that are otherwise eligible for reimbursement under the program.

Health care or mental health care services includes speech therapy, physical therapy, occupational therapy, hospice care, home health care, substance use disorder treatment, and pediatric behavioral health care.

SOURCE: CO Revised Statutes 25.5-5-320 as proposed to be amended by HB 24-1045 (2024 Session). (Accessed Aug. 2024).

Services may be rendered via telemedicine when the service is:

• A covered Health First Colorado benefit,
• Within the scope and training of an enrolled provider’s license, and
• Appropriate to be rendered via telemedicine.

All services provided through telemedicine shall meet the same standard of care as in-person care.

Refer to the Telemedicine Website for a list of billing codes which may be used with Place of Service (POS) 02 or 10.

The reimbursement rate for a telemedicine service shall, as a minimum, be set at the same rate as the medical assistance program rate for a comparable in-person service.

Providers may only bill procedure codes which they are already eligible to bill.

Place of Services codes 02 and 10 can be used during telehealth encounters:

• POS 02: Telehealth provided other than in the patient’s home. The location where health services and health related services are provided or received, through telecommunication technology. Patient is not located in their home when receiving health services or health related services through telecommunication technology.
• POS 10: Telehealth Provided in Patient’s Home. The location where health services and health related services are provided or received through telecommunication technology. Patient is located in their home (which is a location other than a hospital or other facility where the patient receives care in a private residence) when receiving health services or health related services through telecommunication technology.

Additionally, modifiers FQ, FR, 93, and 95 can be added to POS 2 and 10:

• FQ: The service was furnished using audio-only communication technology.
• FR: The supervising practitioner was present through two-way, audio/video communication technology.
• 93: Synchronous Telemedicine Service Rendered Via Telephone or Other Real-Time Interactive Audio-Only Telecommunications System
• 95: Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System

SOURCE: CO Department of Health Care Policy and Financing.  “Telemedicine – Provider Information”, CO Department of Health Care Policy and Financing, CO Department of Health Care Policy and Financing.  “Telemedicine Billing Manual”, 5/24. (Accessed Aug. 2024).

Physician services may be provided as telemedicine in accordance with Section 8.095.

SOURCE: Colorado Adopted Rule 8.200.3.B. (Accessed Aug. 2024).

Any Health First Colorado-covered physician services that are within the scope of a provider’s practice and training and appropriate for telemedicine may be rendered via telemedicine.

SOURCE: CO Department of Health Care Policy and Financing.  “Telemedicine – Provider Information”. (Accessed Aug. 2024).

Procedure codes listed below under “Telemedicine Modifier GT” will receive an additional $5.00 to the fee listed on the most recent Health First Colorado Fee Schedule when billed using modifier GT.

SOURCE: CO Department of Health Care Policy and Financing.  “Telemedicine Billing Manual” 5/24.  (Accessed Aug. 2024).

SOURCE: Colorado Adopted Rule 8.095.2, 8.095.4, 8.095.7. (Accessed Aug. 2024).

Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Services

Other health care services may include other EPSDT benefits if the need for such services is identified. The services are a benefit when they meet the following requirements:

1. All goods and services described in Section 1905(a) of the Social Security Act are a covered benefit under EPSDT when medically necessary as defined at 10 C.C.R. 2505-10, Section 8.076.1.8, regardless of whether such goods and services are covered under the Colorado Medicaid State Plan.
2. For the purposes of EPSDT, medical necessity includes a good or service that will, or is reasonably expected to, assist the client to achieve or maintain maximum functional capacity in performing one or more Activities of Daily Living; and meets the criteria set forth at Section 8.076.1.8.b – g.
3. The service provides a safe environment or situation for the child.
4. The service is not for the convenience of the caregiver.
5. The service is medically necessary.
6. The service is not experimental or investigational and is generally accepted by the medical community for the purpose stated.
7. The service is the least costly.

SOURCE: CO Department of Health Care Policy and Financing.  “Telemedicine Billing Manual” 5/24. (Accessed Aug. 2024).

Durable Medical Equipment Encounters

Face-to-face encounters for durable medical equipment, prosthetics, orthotics, and supplies may be performed via telehealth if available.

Telehealth visits are allowed for reauthorization of continuous glucose monitoring in some cases.

SOURCE: CO Department of Health Care Policy and Financing.  “Durable Medical Equipment, Prosthetics, Orthotics, and Supplies”, 7/24. (Accessed Aug. 2024).

Certain providers are authorized to order durable medical equipment and may conduct a related face-to-face encounter via telehealth or telemedicine if those services are covered by the Medical Assistance Program.

SOURCE: Colorado Adopted Rule 8.590.7.N. (Accessed Aug. 2024).

Pediatric Behavioral Therapy

Pediatric Behavioral Therapists are covered under the telemedicine policy.

SOURCE: CO Department of Health Care Policy and Financing.  “Pediatric Behavioral Therapies Billing Manual”, 8/24 (Accessed Aug. 2024). 

Pediatric Behavioral Therapy (PBT) providers will not be required to collect Electronic Visit Verification (EVV) data when the services are delivered via telehealth, effective May 1, 2023. EVV remains a requirement for all other PBT services when delivered in the home or community.

SOURCE: CO Dept. of Health Care Policy and Financing. Provider Bulletin. May 2023. (Accessed Aug. 2024).

Screening Brief Intervention Treatment

Screening Brief Intervention Treatment may be provided via telemedicine (simultaneous audio and video transmission or by telephone audio-only) with the member.

SOURCE: CO Department of Health Care Policy and Financing.  “Screening, Brief Intervention and Referral to Treatment”, 3/23. (Accessed Aug. 2024).

Education-Only Services

Colorado Medicaid provides reimbursement for education-only services provided through telemedicine. This includes services such as Diabetes Self-Management Education and Support (DSMES) and tobacco cessation counseling.

SOURCE: CO Department of Health Care Policy and Financing. Provider Bulletin B1900434. Aug. 2019. (Accessed Aug. 2024). 

Education-only services was removed from the list of “Not Covered Services” section in the provider manual in June 2019.

SOURCE: CO Department of Health Care Policy and Financing.  “Telemedicine Billing Manual” 5/24. (Accessed Aug. 2024).

Abortion Services

Certain medicinal abortion services may be provided by telemedicine. Physicians (MDs/DOs), Certified Nurse Midwives (CNMs), Advanced Practice Nurses (APNs) or Physician Assistants (PAs) who wish to prescribe Mifepristone must complete a Prescriber Agreement Form prior to ordering and dispensing Mifepristone. The medicinal abortion method (not available for use in maternal life-endangering situations) can be provided by these identified provider types and identified places of service effective May 21, 2021, when prescribed or dispensed and provided by eligible Mifepristone-prescribing practitioners.

HCPCS S0199 covers:

• Office visit #1 or telemedicine counseling/communications
  • Patient check-in or telemedicine services, all counseling and consultation
  • Confirmation of pregnancy and fetal gestational age (either by hCG or ultrasound)
• Follow-up, may include a second office visit or consultation via telemedicine
  • Patient consultation: may include telemedicine consult or office visit check-in with in-person consult.
  • Confirmation of pregnancy termination (either by hCG or ultrasound)

Please see Provider Bulletin for further billing information and related requirements.

SOURCE: CO Department of Health Care Policy and Financing. Provider Bulletin B2200472. Jan. 2022. (Accessed Aug. 2024).

FQHC/RHC

Health First Colorado allows telemedicine visits to qualify as billable encounters for Federally Qualified Health Centers (FQHCs), Rural Health Clinic (RHCs), and Indian Health Services (IHS). Services allowed under telemedicine may be provided via telephone, live chat, or interactive audiovisual modality for these provider types.

When a Federally Qualified Health Center or a Rural Health Clinic provides care through telemedicine, the claim must include the modifier GT on line(s) identifying the service(s).

When used by an FQHC or RHC, the modifier GT identifies the services as being delivered through telemedicine modality. There is no enhanced payment to FQHCs and RHCs when using the modifier GT.

SOURCE: CO Department of Health Care Policy and Financing.  “Telemedicine Billing Manual” 5/24. (Accessed Aug. 2024).

For Health First Colorado a billable encounter at an FQHC and RHC is an in person or telemedicine face to face visit with a Health First Colorado member. Telemedicine services are limited to the procedure codes identified in the Telemedicine Billing Manual. Services provided via telemedicine must use modifier GT on the claim. All other claim submission information is the same.

Additionally, modifiers FQ and FR can be added to the claim:

• FQ: The service was furnished using audio-only communication technology.
• FR: The supervising practitioner was present through two-way, audio/video communication technology.

SOURCE: CO FQHC & RHC Billing Manual 5/24. (Accessed Aug. 2024).

The visit definition for a FQHC includes interactive audio (including but not limited to telephone and relay calls), interactive video (including but not limited to interactive audiovisual modalities), or interactive data communication (including but not limited to live chat and excluding text messaging, electronic mail, and facsimile transmission) encounters in accordance with Section 8.095.  Any health benefits provided through interactive audio (including but not limited to telephone and relay calls), interactive video (including but not limited to interactive audiovisual modalities), or interactive data communication (including but not limited to live chat and excluding text messaging, electronic mail, and facsimile transmission) must meet the same standard of care as in-person care in accordance with Section 8.095.

SOURCE: Colorado Adopted Rule 8.700.1. (Accessed Aug. 2024).

Visit for a RHC means a face-to-face encounter, or an interactive audio (including but not limited to telephone and relay calls), interactive video (including but not limited to interactive audiovisual modalities), or interactive data communication (including but not limited to live chat and excluding text messaging, electronic mail, and facsimile transmission) encounter in accordance with Section 8.095 between a clinic client and any health professional providing the services set forth in 8.740.4. Any health benefits provided through interactive audio, interactive video, or interactive data communication must meet the same standard of care as in-person care.

SOURCE: Colorado Adopted Rule 8.740.1. (Accessed Aug. 2024).

Long Term Services and Supports (LTSS), Home and Community-based Services (HCBS), Services for Individuals with Intellectual and Developmental Disabilities, Early Childhood Intervention Services

Upon department approval, certain eligibility determinations, assessments, referrals, and monitoring contacts may be completed by case managers at an alternate location, via telephone or using virtual technology methods. Such approval may be granted for situations in which face-to-face meetings would pose a documented safety risk to the case manager or Client (e.g. natural disaster, pandemic, etc.).

SOURCE: 10 CCR 2505-10 8.393; 8.506.4.B; 8.508.70; 8.509; 8 CCR 1405-1. (Accessed Aug. 2024).

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

Targeted case management via telephone and video is listed as allowed. See manual.

SOURCE: CO Dep. of Health Care Policy and Financing, Home and Community-Based Services for Persons with Intellectual and/or Developmental Disabilities Waiver Programs & Targeted Case Management for Home and Community-Based Services Waiver Programs, Last revised 6/23/24, (Accessed Aug. 2024).

Home and Community-Based Services

Home and Community-Based Services Telehealth (HCBS Telehealth) is a method of service delivery of certain HCBS services listed at Section 8.615.2.

SOURCE: 10 CCR 2505-10 8.615.1 (M). (Accessed Aug. 2024).

Members eligible to use HCBS Telehealth are those enrolled in the waivers and services as defined in this rule at Section 8.7100. Additional requirements include:

• The Case Management Agency shall ensure the use of HCBS Telehealth is the choice of the Member through the Person-Centered Support Planning process by indicating the Member’s choice to receive HCBS Telehealth in the Department prescribed IT system.
• Through the Person-Centered Support Planning process, the Case Management Agency shall identify and address the benefits and possible detriments to Members choosing to use HCBS Telehealth for service delivery.
• HCBS Telehealth delivery must be prior authorized and documented in the Member’s Person-Centered Support Plan.
• Telehealth as a service delivery method for authorized HCBS Waiver Services, shall not interfere with any individual rights or be used as any part of a Rights Modification plan.
• Provider Agencies that provide HCBS Telehealth services shall establish and maintain documented policies on the use of Telehealth services that comply with Section 8.7559.

HCBS Telehealth may be used to deliver support through authorized HCBS Waiver Services listed at Section 8.7559A. See Sec. 8.7559 for additional information on services authorized for consultation through telehealth, HCBS telehealth exclusions and limitations, as well as HCBS telehealth provider agency requirements, which include that providers that choose to use HCBS Telehealth shall develop and make available a written HCBS Telehealth Policy which includes that providers shall ensure the use of HCBS Telehealth is the choice of the Member. HCBS Waiver providers must be able to use a technology solution that allows real-time interaction with the Member which may include audio, visual and/or tactile technologies. Providers shall not use HCBS Telehealth to address a Member’s emergency needs. 

HCBS Telehealth does not include reimbursement for the purchase or installation of Telehealth equipment or technologies. HCBS Waiver service providers utilizing Telehealth shall follow all billing policies and procedures as outlined in the Department’s current waiver billing manuals and rates/fees schedules. This includes the prohibition on collecting copayments or charging Members for missing set times for services.

SOURCE: 10 CCR 2505-10, Sec. 8.7202H, 8.7408, 8.7559. (Accessed Aug. 2024).

Adult Day Services (ADS)

Adult Day Services (ADS) may be provided out of an Adult Day Services Center or through Non-Center-Based means including Telehealth.

Telehealth Adult Day Services are provided through virtual means in a group or on an individual basis. Telehealth ADS are ways for participants to engage in activities, with their community, and connect to staff and other ADS participants virtually or over the phone, only if a participant does not have access or the ability to use video chat technology. Services provided through Telehealth are not required to provide nutrition services. See rules for staffing, documentation, billing and written policy requirements specific to use of telehealth ADS.

SOURCE: 10 CCR 2505-10 8.491; 8.7504B. (Accessed Aug. 2024).

Telehealth Day Habilitation services

Telehealth Specialized Habilitation services includes provider-hosted virtual meetings, groups, and activities where Members virtually engage and interact with provider staff, volunteers, and other Members.

Telehealth Supported Community Connections services includes virtual meetings, groups and activities, that are hosted by non-provider entities where Members virtually engage and interact with persons without disabilities other than those individuals who are providing services to the Member.

SOURCE: 10 CCR 2505-10 Sec. 8.7516. (Accessed Aug. 2024).

Mobile Crisis Response (MCR) Services

MCR services may be provided via Telemedicine in accordance with Section 8.095 by any one (1) member of the MCR provider’s team, where appropriate. The initial Telemedicine face-to-face crisis response must include at least (1) in-person responder from the MCR team.

SOURCE: 10 CCR 2505-10 8.020. (Accessed Aug. 2024).

Behavioral Health

“Session” means a face-to-face, telehealth, or audio-only interaction of the individual and personnel. Session may include but is not limited to individual therapy, group therapy, medication-assisted treatment education and/or monitoring, family therapy, peer professional services, educational/occupational groups, recreational therapy, intake, discharge, service planning, and other therapies.

The BHE may use telehealth methods for the provision of services under these regulations except for services that specifically require in-person contact. If a service is allowable via telehealth according to state and federal regulations, appropriate methods will be noted within the applicable endorsement Chapter. If an individual prefers to receive services in-person and the BHE does not offer the appropriate service in-person, the BHE shall refer the individual to another entity that offers the service in-person.

If the BHE uses telehealth methods, it must develop and implement policies and procedures regarding telehealth services, including:

• Collection of required signatures;
• Training for personnel specific to the modality or manner for determining competence with the modality;
• Procedure for personnel response if an individual experiences an emergency while receiving services via telehealth, including collection of information about the individual’s remote location for each session;
• Confidentiality protocols designed to protect the individual’s privacy in accordance with state and federal law; and
• Specification as to whether policies apply to the BHE as a whole, a physical location, or a specific endorsement, as appropriate.

Services provided via telehealth methods must be documented in the individual’s record, consistent with documentation requirements for in-person services.

Screenings should be conducted in-person unless contraindicated. If contraindicated, screenings may be conducted via audio-visual or audio only telehealth. Clinical rationale must be documented in the case of a telehealth screening.

A peer support professional may provide services in a variety of settings, if permitted access, that may include but are not limited to audio-visual or audio-only telehealth.

Early intervention services may be delivered via telehealth in accordance with the standards set in part 2.9 of these rules.

Various outpatient services may be delivered via in-person, audio-visual telehealth, or audio-only telehealth format in accordance with part 2.9 of these rules.

Walk-In crisis services follow-up communication may be conducted face-to-face, via telehealth, or via telephone only, based on an individual’s clinical need and preferences. Telehealth may be used to secure expertise for individuals served by the mobile crisis response team with a physical or I/DD.

If telehealth services do not best meet the needs of the individual and the BHE endorsed to provide DUI/DWAI programming cannot accommodate in-person services, the BHE must refer the individual to a provider that can meet the individual’s needs. Level II Four Plus must be completed as in-person services. 1. Telehealth may only be utilized if clinically indicated for the individual, or if the individual is unable to attend in-person. Documentation must be present in the individual record stating why telehealth was utilized.

BHE policies and procedures should include how telehealth services are deployed, how individual preference for in-person services are addressed, and when based on diagnosis or other need, telehealth services are not appropriate.

Essential behavioral health safety net providers offering outpatient behavioral health services must have in-person service offerings in addition to any telehealth services the agency may elect to provide.

SOURCE: 2 CO Code of Regulation 502-1, 1.2, p. 18, 2.9, p. 40, 2.12, p. 49, 3.2, p. 91, 4.2, p. 94, 4.3, p. 96, 4.6, p. 104, 4.7, p. 106, 6.3, p. 149, 151, 156, 10.5, p. 184, 10.9, p. 193, 12.3, p. 284, 12.4, p. 293, 21.6, p. 475. (Accessed Aug. 2024).

School-Linked Health Care Services

School-linked health care services, meaning primary health-care services, behavioral health-care services, oral health-care services, or preventative health-care services, may be delivered through telehealth, mobile services, or referrals for health-care services at a clinic located near school grounds.

SOURCE: CO Statute Sec. 25-20.5-502 as proposed to be amended by SB 24-034 (2024 Session). (Accessed Aug. 2024).

School Health Services

Telehealth codes listed as eligible with GT modifier throughout manual.

SOURCE: CO Dep. of Health Care Policy and Financing, School Health Services, Last revised 7/1/24, (Accessed Aug. 2024).

Doula Services

Doula services are billed using two Healthcare Common Procedure Coding System (HCPCS) procedure codes, two International Classification of Diseases (ICD)-10 diagnosis codes, and a combination of modifier codes if services are delivered via telemedicine. The modifier codes shown below should only be used in circumstances involving telemedicine.

See billing manual for codes that are allowed via telehealth.

Doulas can provide prenatal and postpartum care in variety of settings, including the member’s home, clinics and provider offices, community-based settings or via telehealth. A full list of allowable places of service for doula services are indicated below. 

Labor and delivery services (T1033) cannot be provided via telemedicine with Place of Service codes 02 or 10. While doulas must provide in-person labor and delivery support, location can vary.

SOURCE: CO Dep. of Health Care Policy and Financing, Doula Billing Manual, Last revised 8/9/24, (Accessed Aug. 2024).

Pharmacy Services

Some codes are allowed for telemedicine delivery. Refer to the Telemedicine Services web page for more detail.

SOURCE: CO Dep. of Health Care Policy and Financing, Pharmacy Services, Last revised 2/29/24, (Accessed Aug. 2024).

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ELIGIBLE PROVIDERS

SOURCE: Colorado Adopted Rule 8.095.3. CO Department of Health Care Policy and Financing. “Telemedicine Billing Manual” 5/24. (Accessed Aug. 2024).

All distant providers should bill the appropriate procedure code and Place of Service 02 or 10 and FQ or FR modifiers if appropriate on the CMS 1500 paper claim form or as an 837P transaction.

The following distant provider types may bill using modifier GT:

• Physician
• Clinic
• Osteopath
• FQHC
• Doctorate Psychologist
• MA Psychologist
• Physician Assistant
• Nurse Practitioner
• RHC

A primary care provider (PCP) is eligible to be reimbursed as the ‘originating provider’ when present with the patient. In order for a PCP to be reimbursed as a distant provider, the PCP must be able to facilitate an in-person visit in the state of CO if necessary for treatment of the member’s condition.

A specialist is eligible to be an originating provider (if present with the patient) or distant provider.

The distant provider may participate in the telemedicine interaction from any appropriate location.

When the patient is located in a hospital, please use the appropriate place of service code for where the patient is located.

SOURCE: CO Department of Health Care Policy and Financing. “Telemedicine Billing Manual” 5/24. (Accessed Aug. 2024).

Health First Colorado has expanded the list of providers eligible to deliver telemedicine services to include FQHCs, RHCs, IHS, physical therapists, occupational therapists, home health providers, hospice and pediatric behavioral health providers. Outpatient physical, occupational and speech therapy services must have an interactive audio/visual connection with the member to be provided via telemedicine.

SOURCE: CO Dept. of Health Care Policy and Financing, Provider Bulletin, June 2023. (Accessed Aug. 2024).

Physical Therapists, Occupational Therapists, Hospice, Home Health Providers and Pediatric Behavioral Health Providers

Physical therapists, occupational therapists, hospice, home health providers and pediatric behavioral health providers are eligible to deliver telemedicine services.

1. Home Health Agency services and therapies, Hospice, and Pediatric Behavioral Treatment may be provided via telephone-only.
2. Outpatient Physical, Occupational, and Speech Therapy services must have an interactive audio/visual connection with the member to be provided via telemedicine.

Telemedicine is covered for behavioral health providers under the capitated behavioral health benefit administered by the Regional Accountable Entities (RAEs). Behavioral health providers should contact their RAE for guidance. Visit the Accountable Care Collaborative Phase II web page for more information.

SOURCE: CO Department of Health Care Policy and Financing. “Telemedicine Billing Manual” 5/24. (Accessed Aug. 2024).

RHC/IHS/FQHC

A telemedicine service meets the definition of a face-to-face encounter for a rural health clinic, Indian health service, or federally qualified health center.  The reimbursement rate for a telemedicine service provided by a rural health clinic or federal Indian health service or federally qualified health center must be set at a rate that is no less than the medical assistance program rate for a comparable face-to-face encounter or visit.

SOURCE: CO Statute, Sec. 25.5-5-320. (Accessed Aug. 2024).

For Health First Colorado a billable encounter at an FQHC and RHC is an in person or telemedicine face to face visit with a Health First Colorado member. Telemedicine services are limited to the procedure codes identified in the Telemedicine Billing Manual. Services provided via telemedicine must use modifier GT on the claim. All other claim submission information is the same. Additionally, modifiers FQ and FR can be added to the claim:

• FQ: The service was furnished using audio-only communication technology.
• FR: The supervising practitioner was present through two-way, audio/video communication technology.

SOURCE: CO Dep. of Health Care Policy and Financing, FQHC/RHC Services, Last revised 5/15/24, (Accessed Aug. 2024).

SOURCE: Colorado Adopted Rule 8.095.1, 8.095.3, 8.095.4, 8.095.6. (Accessed Aug. 2024).

As of October 30th, 2022, there is a provider specialty type for Clinic and Non-Physician Practitioner groups that meet the following definition:

• An eHealth entity is defined as a group practice that delivers services exclusively through telemedicine and is enrolled in a provider type that has an eHealth specialty.  Providers who meet this definition must update their enrollment to this provider specialty type.

SOURCE: CO Department of Health Care Policy and Financing. “Telemedicine Billing Manual” 5/24. (Accessed Aug. 2024).

The telemedicine rule 10 CCR 2505-10 8.095 regarding eHealth entities is effective as of October 30, 2022. An eHealth entity is defined as a group practice that delivers services exclusively through telemedicine and is enrolled in a provider type that has an eHealth specialty.

• Telemedicine-only providers are to use Specialty Code 878.
• Telemedicine and in-person providers will continue to use the appropriate specialty code for their chosen provider type.

SOURCE: CO Department of Health Care Policy and Financing, Health First CO Provider Bulletin B2200485, (Nov. 2022), (Accessed Aug. 2024).

Ambulatory Surgery Centers & Immunizations Manual

For distant provider use procedure code + modifier GT.

SOURCE: CO Dep. of Health Care Policy and Financing, Ambulatory Surgery Centers (ASC) Billing Manual, Last revised 5/18/23, & Immunizations Billing Manual, Last revised 7/5/24, (Accessed Aug. 2024).

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ELIGIBLE SITES

If no originating provider is present during a Telemedicine Services appointment, then the location of the originating site is at the member’s discretion and can include the member’s home. However, members can be required to choose a location suitable to delivery of telemedicine services that may include adequate lighting and environmental noise levels suitable for easy conversation with a provider.

Services can be provided via telemedicine between a member and a distant provider when a member is located in their home or other location of their choice.

A primary care provider (PCP) is eligible to be reimbursed as the ‘originating provider’ when present with the patient. In order for a PCP to be reimbursed as a distant provider, the PCP must be able to facilitate an in-person visit in the state of CO if necessary for treatment of the member’s condition.

A specialist is eligible to be an originating provider (if present with the patient) or distant provider.

If practitioners at both the originating site and the distant site provide the same service to the member, both providers submit claims using the same procedure code with modifier 77 (Repeat procedure by another physician).

SOURCE: CO Department of Health Care Policy and Financing.  “Telemedicine Billing Manual” 5/24. (Accessed Aug. 2024).

Telemedicine can work:

• From a provider office:  You can connect through video with a provider in another office. Both offices must have telemedicine equipment.
• From your home or other location like a library:  You may be able to use your mobile phone, tablet or desktop computer to connect to a provider. Health First Colorado will not pay for the equipment.

SOURCE: CO Department of Health Care Policy and Financing. “Telemedicine”. (Accessed Aug. 2024).

Eligible place of service includes Telemedicine, including interactive audio (including but not limited to telephone and relay calls), interactive video (including but not limited to interactive audiovisual modalities), or interactive data communication (including but not limited to live chat and excluding text messaging, electronic mail, and facsimile transmission). Any health benefits provided through interactive audio (including but not limited to telephone and relay calls), interactive video (including but not limited to interactive audiovisual modalities), or interactive data communication (including but not limited to live chat and excluding text messaging, electronic mail, and facsimile transmission) must meet the same standard of care as in-person care.

SOURCE:  Colorado Adopted Rule 8.200.3.B.3.D.2.c.7. (Accessed Apr. 2024).

Speech Therapy

Telemedicine POS 02 and Telehealth POS 10 are allowed place of service codes.

SOURCE: CO Department of Health Care Policy and Financing.  “Speech Therapy”, 7/24. (Accessed Aug. 2024). 

Therapy Providers

POS Code 02 or 10 should be used to report services delivered via telecommunication depending on the location of the member when receiving telehealth services. POS 02 is used when the member is receiving telehealth service in a place that is not their home. POS 10 is used when a member is receiving telehealth services when the member is located in their home.

Outpatient physical, occupational, and speech therapy services must have an interactive audio/visual connection with the member to be provided via telemedicine.

SOURCE: CO Department of Health Care Policy and Financing. Provider Bulletin B2200480. July 2022. (Accessed Aug. 2024).

Physical Therapy and Occupational Therapy

Place of Service Codes

• 02 – Telemedicine – Not provided in patient’s home (only applicable to certain procedure codes). Refer to the Telemedicine Billing Manual.
• 10 – Telehealth – Provided in patient’s home. Refer to the Telemedicine Billing Manual.

Telemedicine place of service (POS) code 02 is available for specific procedure codes. Visit the Telemedicine – Provider Information web page for a list of allowed procedure codes.

SOURCE: CO Dep. of Health Care Policy and Financing, Physical Therapy and Occupational Therapy Billing Manual, Last revised 7/24/24, (Accessed Aug. 2024).

Home Health Services

Services shall be provided in the client’s place of residence or one of the following places of service:  Services may be provided using interactive audio (including but not limited to telephone and relay calls), interactive video (including but not limited to interactive audiovisual modalities), or interactive data communication (including but not limited to live chat and excluding text messaging, electronic mail, and facsimile transmission) instead of in-person contact. Any health benefits provided through interactive audio, interactive video, or interactive data communication must meet the same standard of care as in-person care.

SOURCE: Colorado Adopted Rule 8.520.4.B.g. (Accessed Aug. 2024).

Telehealth monitoring is available for members who are eligible through the Home Health benefit and should not be billed as telemedicine. Providers rendering telehealth monitoring should consult the Home Health Billing Manual on the Billing Manuals web page under the CMS 1500 drop-down.

SOURCE: CO Department of Health Care Policy and Financing.  “Telemedicine Billing Manual” 5/24. (Accessed Aug. 2024).

Family Planning Services

Eligible places of service include telemedicine provided in accordance with Section 8.095.

SOURCE: Colorado Adopted Rule 8.730.3.B. (Accessed Aug. 2024).

FQHC/RHC

FQHCs, RHCs, and IHS providers can serve as an originating site allowing a member to connect with a distant provider that is not affiliated with the originating site. The service must be submitted on a professional service claim form (the 1500). Refer to the Telemedicine Billing Manual for the coverage of the originating site procedure code.

SOURCE: CO Dep. of Health Care Policy and Financing, FQHC/RHC Services, Last revised 5/15/24, (Accessed Aug. 2024).

Doula Services

Doulas can provide prenatal and postpartum care in variety of settings, including the member’s home, clinics and provider offices, community-based settings or via telehealth. A full list of allowable places of service for doula services are indicated below.

Labor and delivery services (T1033) cannot be provided via telemedicine with Place of Service codes 02 or 10. While doulas must provide in-person labor and delivery support, location can vary.

Allowed Place of Service Codes

• 02 – Telehealth Provided Other than in Patient’s Home
• 10 – Telehealth Provided in Patient’s Home

SOURCE: CO Dep. of Health Care Policy and Financing, Doula Billing Manual, Last revised 8/9/24, (Accessed Aug. 2024).

Pediatric Behavioral Therapies

Place of Service:

• 02 –  Telemedicine (Refer to the Telemedicine Billing Manual)

Telemedicine place of service (POS) code 02 is available for specific procedure codes. Visit the Telemedicine – Provider Information web page for a list of allowed procedure codes.

SOURCE: CO Dep. of Health Care Policy and Financing, Pediatric Behavioral Therapies Billing Manual, Last revised 8/12/24, (Accessed Aug. 2024).

Pharmacy Services

Allowed Place of Service Codes

• 02 – Telemedicine, other than in patient’s home (only applicable to certain procedure codes, see details below)
• 10 – Telemedicine, in patient’s home (only applicable to certain procedure codes, see details below)

Telemedicine place of service (POS) codes 02 and 10 are available for specific procedure codes. Refer to the Telemedicine Billing Manual for further details.

SOURCE: CO Dep. of Health Care Policy and Financing, Pharmacy Services Billing Manual, Last revised 2/29/24, (Accessed Aug. 2024).

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GEOGRAPHIC LIMITS

No Reference Found.

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FACILITY/TRANSMISSION FEE

In some cases, the originating provider site will not be providing clinical services, but only providing a site and telecommunications equipment. In this situation, the telemedicine originating site facility fee is billed using procedure code Q3014.

Originating providers bill as follows:

• If the originating provider is making a room and telecommunications equipment available but is not providing clinical services, the originating provider bills Q3014 (the procedure code for the telemedicine originating site facility fee).
• If the originating provider also provides clinical services to the member, the provider bills the rendering provider’s appropriate procedure code and bills Q3014.
• The originating provider may also bill, as appropriate, on the UB-04 paper claim form or as an 837I transaction for any clinical services provided on-site on the same day that a telemedicine originating site claim is made. The originating provider must submit two separate claims for the member’s two separate services.

Providers eligible for the originating site facility fee include:

• Physician
• Clinic
• Osteopath
• FQHC
• Doctorate Psychologist
• MA Psychologist
• Physician Assistant
• Nurse Practitioner
• RHC

Provider types not listed above may facilitate Telemedicine Services with a distant provider but may not bill procedure code Q3014. Examples include Nursing Facilities, Intermediate Care Facilities, Assisted Living Facilities, etc.

When an originating site bills Q3014 (telemedicine originating site facility fee), there is generally no rendering provider actually involved in the service at the originating site. However, a rendering provider number is still required and must be affiliated with the billing provider. The facility may enter either the member’s usual provider’s number, or another provider number affiliated with that site as the rendering provider. When the member sees a rendering provider at the originating site and also uses the site as the telemedicine originating site, the facility bills the rendered service procedure code and Q3014 for the use of the telemedicine facility. The same rendering provider number is entered in field 19D.

Using modifier GT with specific codes adds $5.00 to the fee listed for the service.  A specific list of eligible codes is provided in the manual.  Other codes can be billed, but don’t pay the telemedicine transmission fee.

SOURCE: CO Department of Health Care Policy and Financing.  “Telemedicine Billing Manual” 5/24. (Accessed Aug. 2024).

The state department shall establish rates for transmission cost reimbursement for telemedicine services, considering, to the extent applicable, reductions in travel costs by health care or mental health care providers and patients to deliver or to access such services and such other factors as the state department deems relevant.

SOURCE: CO Revised Statutes 25.5-5-320(3). (Accessed Aug. 2024).

Ambulatory Surgery Centers & Immunizations

Telemedicine: For originating provider use procedure code Q3014.

SOURCE: CO Dep. of Health Care Policy and Financing, Ambulatory Surgery Centers (ASC) Billing Manual, Last revised 5/18/23, & Immunizations Billing Manual, Last revised 7/5/24,  (Accessed Aug. 2024).

Last updated 08/14/2024

Miscellaneous

Services appropriately billed to managed care should continue to be billed to managed care. All managed care requirements must be met for services billed to managed care. Managed care may or may not reimburse telemedicine costs.

SOURCE: CO Department of Health Care Policy and Financing.  “Telemedicine Billing Manual” 5/24. (Accessed Aug. 2024).

Specialty Code 878 is a new code that will be added to the Colorado interChange for Provider Types 16 (Clinic) and 25 (Non-Practitioner). Telemedicine only providers are to use Specialty Code 878. Telemedicine and in-person providers will continue to use the appropriate specialty code for their chosen provider type. Providers choosing telemedicine can only have one specialty. The telemedicine specialty does not allow Primary Care Medical Provider (PCMP) enrollment with a Regional Accountable Entity (RAE).

SOURCE: CO Department of Health Care Policy and Financing. Provider News, Issue 48. May 2022. (Accessed Aug. 2024).

Telemedicine Confidentiality Requirements

All Health First Colorado providers using telemedicine to deliver Health First Colorado services must employ existing quality-of-care protocols and member confidentiality guidelines when providing telemedicine services. Health benefits provided through telemedicine must meet the same standard of care as in-person care. Record-keeping should comply with Health First Colorado requirements in 10 CCR 2505-10, Section 8.130.2.

Transmissions must be performed on dedicated secure lines or must utilize an acceptable method of encryption adequate to protect the confidentiality and integrity of the transmission. Transmissions must employ acceptable authentication and identification procedures by both the sender and the receiver. Providers of telemedicine services must implement confidentiality procedures that include, but are not limited to:

• Specifying the individuals who have access to electronic records.
• Using unique passwords or identifiers for each employee or other person with access to the member records.
• Ensuring a system to routinely track and permanently record such electronic medical information.
• Members must be advised of their right to privacy and that their selection of a location to receive telemedicine services in private or public environments is at the member’s discretion.

SOURCE: CO Department of Health Care Policy and Financing.  “Telemedicine Billing Manual” 5/24. (Accessed Aug. 2024).

Last updated 08/14/2024

Out of State Providers

Electronic Health Entity (eHealth Entity) means a group practice that delivers services exclusively through telemedicine and is enrolled in a provider type that has an eHealth specialty. eHealth entities:

1. 1. Cannot be Primary Care Medical Providers
      1. Primary Care Medical Provider (PCMP) means an individual physician, advanced practice nurse or physician assistant, who contracts with a Regional Accountable Entity (RAE) in the Accountable Care Collaborative (ACC), with a focus on primary care, general practice, internal medicine, pediatrics, geriatrics, or obstetrics and gynecology
   2. Can be either in-state or out-of-state.

SOURCE: CO Adopted Rule 8.095.1, 8.095.3. (Accessed Aug. 2024).

Last updated 08/13/2024

Overview

Colorado Medicaid reimburses for live video for medical and mental health services.  They also provide reimbursement for remote patient monitoring and audio-only in certain instances.  Colorado Medicaid requires a member to be present and participating in a telemedicine service, excluding the possibility of utilizing store-and-forward, except in the case of teledentistry for an interim therapeutic restoration. Colorado Medicaid also recently adopted rules to authorize e-consults through the Department’s e-consult platform, which allows asynchronous exchanges between primary care and specialty providers.

Last updated 08/13/2024

Remote Patient Monitoring

POLICY

Telehealth monitoring is available for members who are eligible through the Home Health benefit and should not be billed as telemedicine. Providers rendering telehealth monitoring should refer to the Home Health Billing Manual located on the Billing Manuals web page under the CMS 1500 drop-down menu.

SOURCE: CO Department of Health Care Policy and Financing. “Telemedicine Billing Manual” 5/24. (Accessed Aug. 2024).

The CO Medical Assistance Program will reimburse for home health care or home and community-based services through telemedicine at a flat fee set by the state board.

SOURCE: CO Revised Statutes 25.5-5-321. (Accessed Aug. 2024)

Home care agencies and home care placement agencies rules must allow for supervision in person or by telemedicine or telehealth. Any rules adopted by the board shall be in conformity with applicable federal law and must take into consideration the appropriateness, suitability and necessity of the method of supervision permitted.

SOURCE: CO Revised Statutes 25-27.5-104. (Accessed Aug. 2024).

Home Health Telehealth means the remote monitoring of clinical data transmitted through electronic information processing technologies, from the client to the home health provider which meet HIPAA compliance standards.

SOURCE: 10 CO Code of Regulation 2505-10 8.520.1.L. (Accessed Aug. 2024).

The Home Health Agency shall create policies and procedures for the use and maintenance of the monitoring equipment and the process of telehealth monitoring. The Home Health Agency shall provide monitoring equipment that possesses the capability to measure any changes in the monitored diagnoses and meets all the safety requirements in the regulation. Home Health Telehealth services are covered for clients receiving Home Health Services for telehealth monitoring.

SOURCE: 10 CO Code of Regulation 2505-10 8.520.5.D. (Accessed Aug. 2024).

CO Medicaid reimburses telehealth remote monitoring services including installation and on-going remote monitoring of clinical data through technologic equipment in order to detect minute changes in the member’s clinical status that will allow Home Health agencies to intercede before a chronic illness exacerbates requiring emergency intervention or inpatient hospitalization.

SOURCE: CO Medical Assistance Program, Home Health Billing Manual, (7/24), (Accessed Aug. 2024).

CO Medicaid covers home health telehealth, which includes frequent and ongoing self-monitoring of members through equipment left in the member’s home which is designed to measure the common signs and symptoms of disease exacerbation before a crisis occurs allowing for timely intervention and symptom management.

SOURCE: CO Department of Health Care Policy and Financing.  “Home Health Telehealth”. (Accessed Aug. 2024).

Recently Passed Legislation – Telehealth Remote Monitoring Services for Outpatient Clinical Services

Telehealth remote monitoring means the ongoing remote assessment and monitoring of clinical data through technological equipment in order to detect changes in a member’s clinical status, which allows health-care providers to intervene before a health condition exacerbates and requires emergency intervention or inpatient hospitalization.

On or before September 1, 2024, the state department shall initiate a stakeholder process to determine the billing structure for telehealth remote monitoring for outpatient clinical services. See legislation and Telemedicine Provider Information website for more information on the stakeholder process and requirements.

On or before June 30, 2025, the state board shall promulgate rules regarding the billing structure based on feedback from the stakeholder process.

SOURCE: CO Revised Statutes 25.5-5-337 as proposed to be added by SB 24-168 (2024 Session). (Accessed Aug. 2024).

Recently Passed Legislation – Continuous Glucose Monitors Coverage

Continuous glucose monitor means an instrument or a device designed for the purpose of aiding in the treatment of diabetes by measuring glucose levels on demand or at set intervals through a small, electronic sensor that slightly penetrates an individual’s skin when applied and that is designed to remain in place and active for a least seven days. Beginning November 1, 2025, the state department shall provide coverage for a continuous glucose monitor and related supplies to members under the Medicaid Medical and Pharmacy benefit.

SOURCE: CO Revised Statutes 25.5-5-338 as proposed to be added by SB 24-168 (2024 Session). (Accessed Aug. 2024).

Continuous Glucose Monitor (CGM) Coverage – Refer to the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Billing Manual for CGM criteria with adherence to the member’s regimen and treatment plan.

SOURCE: CO Department of Health Care Policy and Financing. Provider Bulletin. May 2024. (Accessed Aug. 2024).

TCM Monitoring Visits

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.

SOURCE: CO Dep. of Health Care Policy and Financing, Home and Community-Based Services for Persons with Intellectual and/or Developmental Disabilities Waiver Programs & Targeted Case Management for Home and Community-Based Services Waiver Programs, Last revised 6/23/24, (Accessed Aug. 2024).

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CONDITIONS

A member is eligible only if they meet the following criteria:

• Member must receive Home Health services from provider who has opted to provide telehealth services
• Member must require frequent and on-going monitoring/management of their disease or condition
• Member’s home environment must be compatible with the use of the equipment
• Member or caregiver must be willing and able to comply with vital sign self-monitoring
• Member must have one or more of the following diagnoses:
  1. Congestive Heart Failure
  2. Chronic Obstructive Pulmonary Disease
  3. Asthma
  4. Diabetes
  5. Other diagnosis or condition deemed appropriate by the Department or its designee

SOURCE: CO Department of Health Care Policy and Financing.  “Home Health Telehealth”. (Accessed Aug. 2024).

The following requirements must be met:

• Client is receiving services from a home health provider for at least one of the following: congestive heart failure, chronic obstructive pulmonary disease, asthma, or diabetes, pneumonia; or other diagnosis or medical condition deemed eligible by the Department or its Designee.
• Client requires ongoing and frequent, minimum of 5 times weekly, monitoring to manage their qualifying diagnosis, as defined and ordered by a physician or podiatrist;
• Client has demonstrated a need for ongoing monitoring as evidenced by having been hospitalized two or more times in the last twelve months for conditions related to the qualifying diagnosis; or, if the client has received home health services for less than six months, the client was hospitalized at least once in the last three months, an acute exacerbation of a qualifying diagnosis that requires telehealth monitoring, or new onset of a qualifying disease that requires ongoing monitoring to manage the client in their residence;
• Client or caregiver misses no more than 5 transmissions of the provider and agency prescribed monitoring events in a thirty-day period; and
• Client’s home environment has the necessary connections to transmit the telehealth data to the agency and has space to set up and use the equipment as prescribed.

SOURCE: 10 CO Code of Regulation 2505-10 8.520.5.D. (Accessed Aug. 2024).

Recently Passed Legislation – Telehealth Remote Monitoring Services for Outpatient Clinical Services

Beginning July 1, 2025, the state department shall provide reimbursement for the use of telehealth remote monitoring for outpatient clinical services if:

• The member’s health-care provider determines that telehealth remote monitoring is medically necessary based on the member’s medical condition or status;
• The member’s health care provider determines that telehealth remote monitoring would likely prevent the member’s admission or readmission to a hospital, emergency department, nursing facility, or other clinical setting;
• The member is cognitively and physically capable of operating the telehealth remote monitoring devices or equipment or the member has a caregiver who is able and willing to assist with the telehealth remote monitoring device or equipment; and
• The member resides in a setting that is suitable for telehealth remote monitoring and does not have health-care staff on site.

The state board shall promulgate rules regarding additional eligibility requirements. The eligibility requirements must prioritize members who are pregnant and carrying a high-risk pregnancy.

SOURCE: CO Revised Statutes 25.5-5-337 as proposed to be added by SB 24-168 (2024 Session). (Accessed Aug. 2024).

Recently Passed Legislation – Continuous Glucose Monitors Coverage

Beginning November 1, 2025, the state department shall provide coverage for a continuous glucose monitor and related supplies to members under the Medicaid Medical and Pharmacy benefit. Coverage criteria must align with the current glucose monitor local coverage determination standards issued by the Centers for Medicare and Medicaid that are used to determine coverage for Medicare-eligible individuals, including individuals with gestational diabetes not being treated with insulin. Coverage pursuant to this section includes the cost of any necessary repairs or replacement parts for the continuous glucose monitor.

SOURCE: CO Revised Statutes 25.5-5-338 as proposed to be added by SB 24-168 (2024 Session). (Accessed Aug. 2024).

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PROVIDER LIMITATIONS

Any home health agency is eligible to provide services.  A specific list of agencies providing these services via telehealth is listed.

SOURCE: CO Department of Health Care Policy and Financing.  “Home Health Telehealth”. (Accessed Aug. 2024).

Acute home health agencies and long-term home health agencies are reimbursed for the initial installation and education of telehealth monitoring equipment and can be billed once per client per agency. The agency can also bill for every day they receive and review the client’s clinical information.

No prior authorization needed, but agencies should notify the Department or its designee when a client is enrolled in the service.

SOURCE: CO Medical Assistance Program, Home Health Billing Manual, (7/24), (Accessed Aug. 2024).

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OTHER RESTRICTIONS

Home Health services are covered under Medicaid only when all of the following are met:

1. Services are medically necessary.
2. Services are provided under a plan of care as defined at Section 8.520.1 DEFINITIONS.
3. Services are provided on an intermittent basis, as defined at Section 8.520.1, DEFINITIONS.
4. The client meets one of the following:
   1. The only alternative to Home Health services is hospitalization or emergency room care; or
   2. Client’s medical records indicate that medically necessary services should be provided in the client’s home instead of other out-patient setting, according to one or more of the following guidelines:
      1. The client, due to illness, injury or disability, is unable to travel to an outpatient setting for the needed service;
      2. Based on the client’s illness, injury, or disability, travel to an outpatient setting for the needed service would create a medical hardship for the client;
      3. Travel to an outpatient setting for the needed service is contraindicated by a documented medical diagnosis;
      4. Travel to an outpatient setting for the needed service would interfere with the effectiveness of the service; or
      5. The client’s medical diagnosis requires teaching which is most effectively accomplished in the client’s place of residence on a short-term basis.
5. The client is unable to perform the health care tasks for him or herself, and no unpaid family/caregiver is able and willing to perform the tasks; and
6. Covered service types are those listed in Service Types, Section 8.520.5.

SOURCE: 10 CO Code of Regulation 2505-10 8.520.4.A. (Accessed Aug. 2024).

Reimbursement shall not be provided for purchase or lease of telemedicine equipment.

SOURCE: CO Revised Statutes 25.5-5-321. (Accessed Aug. 2024).

Continuous Glucose Monitor (CGM) Coverage

Refer to the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Billing Manual for CGM criteria with adherence to the member’s regimen and treatment plan. Providers must adhere to the following criteria:

• The treating practitioner must have an in-person or telehealth visit with the member to assess adherence to their CGM regimen and diabetes treatment plan every six (6) months following the initial prescription of the CGM.
• Providers must document what education and counseling occurred with the member to improve adherence for the next six (6) months in cases where adherence has not been optimal.

SOURCE: CO Department of Health Care Policy and Financing. Provider Bulletin. May 2024. (Accessed Aug. 2024).

Last updated 08/13/2024

Store and Forward

POLICY

The member must be present during any Telemedicine visit.

SOURCE: CO Department of Health Care Policy and Financing.  “Telemedicine Billing Manual” 5/24. (Accessed Aug. 2024).

Telemedicine may be provided through interactive audio, interactive video, or interactive data communication, including but not limited to telephone, relay calls, interactive audiovisual modalities, and live chat as long as the technologies are compliant with HIPAA. The health care or mental health care services are subject to reimbursement policies developed pursuant to the medical assistance program. Reimbursement rate must be, at minimum, the same as a comparable in-person services.

SOURCE: CO Revised Statutes 25.5-5-320. (Accessed Aug. 2024).

Interim Therapeutic Restorations

In-person contact between a health care provider and a member is not required under the state’s medical assistance program for the diagnosis, development of a treatment plan, instruction to perform an interim therapeutic restoration procedure, or supervision of a dental hygienist performing an interim therapeutic restoration procedure. A health care provider may provide these services through telehealth, including store-and-forward transfer, and is entitled to reimbursement for the delivery of those services via telehealth to the extent the services are otherwise eligible for reimbursement under the program when provided in person. The services are subject to the reimbursement policies developed pursuant to the state medical assistance program.

SOURCE: CO Revised Statutes 25.5-5-321.5 as proposed to be amended by SB 24-176 (2024 Session). (Accessed Aug. 2024).

eConsults

Effective February 1, 2024, eConsults that meet the criteria below are a covered benefit.

An eConsult is defined as an asynchronous dialogue initiated by a Treating Practitioner seeking a Consulting Practitioner’s expert opinion without a face-to-face member encounter with the Consulting Practitioner.

Treating Practitioner is defined as a member’s treating physician or other qualified health care practitioner who is a primary care provider contracted with a Regional Accountable Entity to participate in the Accountable Care Collaborative as a Network Provider.

Consulting Practitioner is defined as a provider who has education, training, or qualifications in a specialty field other than primary care.

Providers can utilize the Department’s eConsult platform, Colorado Medicaid eConsult, or a third-party eConsult platform that meets the Department’s criteria.

Approved Third-party eConsult Platform Criteria

1. Platform must be capable of maintaining documentation that the eConsult is directly relevant to the individual patient’s diagnosis and treatment, and the consulting practitioner has specialized expertise in the particular health concerns of the patient.
2. Platform must be capable of identifying the Colorado Medicaid enrollment status of providers using the platform. All providers must be licensed in the state of Colorado.
3. Platform meets all state and federal privacy laws regarding the exchange of patient information.
4. Platform must be capable of providing sufficient documentation for the treating and consulting provider to demonstrate that the consultation was provided for the direct benefit of the member.
5. Platform must provide the treating and consulting practitioner with the information necessary to file a claim including date of service; name of recipient; Medicaid identification number; name of provider agency or person providing the service; nature, extent, or units of service; and the place of service.

Treating practitioners can bill this service using Procedure Code 99452. Consulting practitioners can bill this service using Procedure Code 99451.

Treating Practitioner Reimbursement:

• All practitioners rendering services should submit claims for completed eConsults for fee-for-service reimbursement.

Consulting Practitioner Reimbursement:

• Consulting practitioners who use the Department’s eConsult platform will be paid by Safety Net Connect’s subcontractor, ConferMED.
• Consulting practitioners who use an approved eConsult platform should submit claims for completed eConsults to the Colorado interChange for fee-for-service reimbursement.

Refer to the Code of Colorado Regulations (1- CCR 2505-10, Section 8.095) for more information.

SOURCE: CO Department of Health Care Policy and Financing.  “Telemedicine Billing Manual” 5/24. (Accessed Aug. 2024).

A Treating Practitioner may request an eConsult with a Consulting Practitioner. eConsult services must:

1. Be requested by the Treating Practitioner through an eConsult Platform;
2. Be responded to by the Consulting Practitioner through an eConsult Platform;
   1. The Consulting Practitioner may send the eConsult to another Consulting Practitioner in a different specialty practice through an eConsult Platform, when clinically appropriate.
3. The Consulting Practitioner must, when clinically appropriate, provide clinical guidance pertaining to the eConsult electronically to the requesting Treating Practitioner through an eConsult Platform; and,
4. All dialogue between the Treating Practitioner and the Consulting Practitioner pertaining to an eConsult must be through an eConsult Platform.

eConsults that are not delivered, and responded to, through an eConsult Platform, are noncovered services.

SOURCE: CO Adopted Rule 8.095.4.C & 8.095.8.B. (Accessed Aug. 2024).

Federally Qualified Health Centers (FQHCs) and Rural Health Centers (RHCs)

eConsult dialogues between Treating Practitioners and Consulting Practitioners do not meet the definition of an FQHC or RHC visit as defined in CCR 8.700. Costs associated with performing eConsults through an FQHC/RHC are considered allowable costs for the cost report and will be included in the calculation of the reimbursement rate for a patient visit at an FQHC/RHC.

SOURCE: CO Department of Health Care Policy and Financing.  “Telemedicine Billing Manual” 5/24; FQHC/RHC Billing Manual (5/24). (Accessed Aug. 2024).

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ELIGIBLE SERVICES/SPECIALTIES

Limited reimbursement allowed for an interim therapeutic restoration in teledentistry.

SOURCE: CO Revised Statutes 25.5-5-321.5 as proposed to be amended by SB 24-176 (2024 Session). (Accessed Aug. 2024).

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GEOGRAPHIC LIMITS

No Reference Found

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FACILITY/TRANSMISSION FEE

No Reference Found