Bulletin Board

Medicaid Fee Schedule Confusion/Clarification

Some confusion has resulted from Medicaid’s decision to no longer list all codes/rates in a single fee schedule. There are now multiple separate fee schedules for different code categories. See below for further details:

All fee schedules are available on the Provider Rates & Fee Schedules web page:

The “Health First Colorado Fee Schedule (master fee schedule)” no longer lists all codes. There are now separate fee schedule spreadsheets for E&M codes, immunizations, dental, etc. So if a code is not listed on the “Health First Colorado Fee Schedule” it may be listed on a benefit-specific fee schedule. Here are the links to the most common fee schedules:

January 2018 Fee Schedule Data File and January 2018 Fee Schedule Instructions
E/M and Vaccine Administration Services
Immunization Rates
HCPCS Rate Updates
Physician Administered Drug Fee Schedule
Dental

Also: The Department of Health Care Policy & Financing and DXC Technology (DXC) are working to implement rate increases for rates approved as of July 1, 2017. DXC will adjust affected claims to apply the new rates to those claims. As a reminder, claims already billed with a rate lower than the new rate cannot be adjusted for the higher rate, as the Department will always use the “lower of” pricing logic. Providers are advised to bill their usual and customary charges. The Department will not waive timely filing rules (to find more information about timely filing, refer to the Frequently Asked Questions web page) to allow providers to adjust and rebill at the new rates. The Department and DXC will keep providers updated on implementing the new rates and reprocessing qualified claims. Please continue to check the provider bulletins for updates on rate increases, fee schedules and reprocessing.