If you came here looking for a single Colorado Medicaid CPT Code Billing chart to download, here is the honest answer that saves you an afternoon: there isn’t one. Health First Colorado, which is the brand name for Colorado’s Medicaid program, doesn’t publish one master chart of every CPT code and rate. Instead, the state posts separate fee schedules by provider type and service category, and you look up the code you need. That sounds like extra work, but it is actually good news, because a real time lookup is always current, while any single downloadable chart is out of date the moment the state changes a rate. This guide shows you how the system really works, where the official rates live, what they pay in 2026, and the mistakes that get Colorado Medicaid claims denied.

 

Where the Real Colorado Medicaid CPT Code Billing Chart Lives

The single source of truth is the HCPF Provider Rates and Fee Schedule page, run by the Colorado Department of Health Care Policy and Financing. You can search a CPT or HCPCS code to see its current rate, or download the full schedule for your specialty. There’s no master PDF because the schedules are split by service. Here is how they break down.

Fee Schedule	Covers	Where the Rate Comes From
Physician services	Office visits, procedures, E/M	The Health First Colorado Physician Fee Schedule (January and April 2026 versions)
Behavioral health	Therapy, evaluations, substance use	Mostly through Regional Accountable Entities, per the State Behavioral Health Services Billing Manual
Laboratory	CDLT and pathology codes	Adjusted per test to match the Medicare Clinical Laboratory Fee Schedule under PAMA
DMEPOS	Equipment, prosthetics, supplies	The DME fee schedule, capped so it does not exceed Medicare in the aggregate
Dental, audiology, and more	Service specific	Separate schedules by provider type on the same HCPF page

So the practical move is not to hunt for a chart. It’s to identify your provider type, open the matching schedule on the HCPF page, and search your code. That habit keeps you on the current rate every time.

The Two Calendar Trap: When Rates and Codes Change

Colorado Medicaid CPT Code Billing runs on two different calendars, and mixing them up is a common source of underpayment. Rate changes follow the state fiscal year, July 1 through June 30, so new rates usually land on July 1. Code changes follow the calendar year, so new CPT and HCPCS codes take effect January 1 to match Medicare. Right now a 1.6 percent across the board increase is in effect, approved for July 1, 2025 through June 30, 2026, and already loaded into the Colorado interChange system. You can confirm it on the HCPF Fee for Service Rate Information page.

One 2026 wrinkle catches billers off guard. The new 2026 CPT and HCPCS codes loaded into the system on January 1, but claims using a brand new code can temporarily suspend with EOB 0000, which means the claim is pending program review while HCPF finishes its system updates. You can bill the code, but payment may wait until the update completes, often around February. That is a delay, not a denial, so don’t resubmit in a panic.

 

Colorado Medicaid CPT Code Billing 2026 Rates for Common Codes

Rates vary by provider type and update through the year, so always confirm your own on the HCPF page. That said, here are verified figures for common behavioral health and office codes for the current period, to show the shape of what Colorado Medicaid pays. Behavioral health for most members runs through Regional Accountable Entities rather than fee for service, which we cover in our mental health billing services.

CPT Code	Service	Rate (USD)
90791	Psychiatric diagnostic evaluation	About 159.67
90834	Psychotherapy, 45 minutes	About 91.09
90837	Psychotherapy, 60 minutes	About 134.51
99202 to 99215	Office and outpatient E/M	Leveled by MDM or total time; search the schedule for the exact rate

Those behavioral health figures reflect the October 2025 through June 2026 period. Laboratory codes follow a different logic: under the Protecting Access to Medicare Act, Colorado adjusts clinical diagnostic lab rates per test to match the Medicare Clinical Laboratory Fee Schedule, and Medicaid cannot pay more than Medicare would for the same test. Always pull the live number before you quote a rate to anyone.

E/M Coding and the Consultation Code Rule

Office and outpatient evaluation and management codes, 99202 through 99215, are among the most billed codes in Colorado Medicaid. HCPF follows CMS guidelines, so you level the visit by either medical decision making or total time on the date of service, the same way you’d for Medicare.

Here is the rule that still trips up billers who move to Colorado from other work. Since 2010, Colorado Medicaid CPT Code Billing has not recognized CPT consultation codes, 99241 through 99245 for office and outpatient, and 99251 through 99255 for inpatient. Bill one and it denies automatically. Use the appropriate E/M code for the setting and the complexity instead. Our medical coding services keep rules like this built into the workflow so a habit from another payer doesn’t cost you a claim.

The Two Payment Pathways: Fee for Service and RAEs

Colorado Medicaid CPT Code Billing doesn’t pay everything the same way, and picking the wrong pathway causes denials. Many physical health services bill fee for service against the schedules above. Behavioral health, though, runs for most members through Regional Accountable Entities, the RAEs, not fee for service, and the State Behavioral Health Services Billing Manual is the authoritative source for mental health and substance use billing. Before you bill, confirm which pathway covers the member and the service. One more rule protects members under 21: under the federal EPSDT mandate, Colorado Medicaid CPT Code Billing must cover any medically necessary service that corrects or improves a condition found on screening, even if that service is not otherwise listed in the state plan.

The Colorado Medicaid CPT Code Billing Denials We Prevent

Most Colorado Medicaid CPT Code Billing denials come from a short, predictable list. Coding and eligibility errors are the leading denial category across healthcare, with industry denial rates between 10 and 15 percent, per 2026 denial benchmarks. Here are the ones that hit Health First Colorado claims.

Common Mistake	What It Causes	How We Prevent It
Wrong CPT code or missing modifier	Denial or underpayment	We code to the current HCPF schedule and apply the required modifiers, including timed versus untimed unit rules
Billing a consultation code (99241 to 99245)	Automatic denial; Colorado dropped these in 2010	We use the correct office or inpatient E/M code instead, per HCPF policy
No prior authorization when required	PAR denial	We check the current bulletin for PAR requirements before the service, since some codes need it even when they are on the schedule
Billing fee for service when the member is in a RAE	Wrong pathway denial	We confirm whether physical or behavioral health routes through a Regional Accountable Entity first
Member coverage not active	Eligibility denial	We verify eligibility before every visit, since coverage changes
Late filing	Timely filing denial	We submit daily and track filing deadlines so claims never age out

One rule deserves its own line, because breaking it carries real penalties: you can’t balance bill a Health First Colorado Medicaid CPT Code Billing member for a covered service. Most services carry no member copay, commercial insurance is billed first when the member has it, and Colorado Medicaid CPT Code Billing uses lower of pricing to set its payment. Billing the member for the difference can trigger sanctions or removal from the network. When a claim does deny, our denial management services work it back and fix the pattern behind it.

How Docscare Handles Colorado Medicaid CPT Code Billing

We bill Medicaid the way each state actually runs it, around the right fee schedule, the right pathway, and the rules that differ from Medicare, not a generic template. For Colorado Medicaid CPT Code Billing, our AAPC-certified coders pull rates from the current HCPF schedules, avoid the retired consultation codes, check prior authorization and RAE pathway before the claim goes out, and never balance bill a member. We submit claims daily by CMS 1500 or 837P and track every filing deadline. When something denies, we work it back and fix the root cause.

We’re a US based medical billing company in Austin, Texas, and we bill for practices across all 50 states, fully HIPAA compliant, running a 99 percent clean claim rate with a 97.45 percent first pass acceptance rate. Medicaid rules shift constantly and vary by state, so having a team that reads every provider bulletin is the difference between full payment and a stack of avoidable denials. See how it fits into our full medical billing services.

Frequently Asked Questions

Is there a single Colorado Medicaid CPT Code Billing chart?

No, and this is the mistake that costs providers the most time. Health First Colorado does not publish one master billing chart. Instead, HCPF posts separate fee schedules organized by provider type and service category, physician, behavioral health, laboratory, DME, dental, and more, on its Provider Rates and Fee Schedule page. To find a rate, you search the code or download the schedule that matches your service. Anyone selling you a single downloadable Colorado Medicaid chart is selling a snapshot that goes stale the next time HCPF updates a rate.

What is Health First Colorado Medicaid CPT Code Billing?

Health First Colorado is the brand name for Colorado’s Medicaid program. They are the same thing. It is administered by the Colorado Department of Health Care Policy and Financing, or HCPF, and it covers more than 1.8 million Coloradans, including children, pregnant members, parents, seniors, and people with disabilities. When a document says Health First Colorado or Colorado Medicaid, it means the same program.

How often do Colorado Medicaid CPT Code Billing rates change?

Colorado Medicaid runs on two calendars, which trips up new billers. The state fiscal year runs July 1 through June 30, and rate changes usually take effect on July 1. The calendar year runs January 1 through December 31, and CPT and HCPCS code updates take effect January 1 to match Medicare. A 1.6 percent across the board increase took effect July 1, 2025 and runs through June 30, 2026. Because rates can change more than once a year, check the current schedule before you bill.

Does Colorado Medicaid CPT Code Billing accept consultation codes?

No. Since 2010, Colorado Medicaid CPT Code Billing has not recognized CPT consultation codes, 99241 through 99245 for office and outpatient, or 99251 through 99255 for inpatient. Billing one is an automatic denial. Use the appropriate evaluation and management code for the setting and complexity instead, the same approach Medicare takes.

Can providers bill Colorado Medicaid CPT Code Billing members for the balance?

No. Providers cannot balance bill Health First Colorado members for covered services, and most services carry no member copay. If a member has commercial insurance, that plan is billed first, and Colorado Medicaid uses lower of pricing to calculate its payment. Balance billing a member can lead to sanctions or removal from the Medicaid provider network, so it is a rule worth building into your workflow.