Code of Colorado Regulations
1100 - Department of Labor and Employment
1101 - Division of Labor Standards and Statistics (Includes 1103 Series)
7 CCR 1101-3 Rule 18 - Rule 18, MEDICAL FEE SCHEDULE (Rule 18 exhibits published separately)
Section 7 CCR 1101-3-18-3 - GENERAL POLICIES

Universal Citation: 1100 CO Code Regs 7 CCR 1101-3-18-3

Current through Register Vol. 47, No. 5, March 10, 2024

(A) BILLING CODES AND FEE SCHEDULE:

(1) The Division establishes the Medical Fee Schedule based on RBRVS, as modified by Rule 18 and its Exhibits.

(2) The Division incorporates CPT®, HCPCS, CDT® and National Drug Code (NDC) codes and values, unless otherwise specified in Rule 18. The providers may use CPT® Category III codes listed in the RBRVS with Payer agreement. Payment for the Category III codes shall comply with Rule 16 policy for unpriced codes.

(3) Division-created codes and values (DoWC ZXXXX) supersede CPT®, HCPCS, CDT®, and NDC codes and values. The CPT® mid-point rule for attaining a unit of time applies to these codes, unless otherwise specified in this Rule.

(4) Codes listed with values of "BR" (by report), not listed, or listed with a zero value and not included by Medicare in another procedure(s), require prior authorization.

(B) PLACE OF SERVICE CODES:

The table below lists the place of service codes corresponding to the RBRVS facility RVUs. All other maximum fee calculations shall use the non-facility RVUs listed in the RBRVS.

Place of Service Code

Place of Service Code Description

21

Inpatient Hospital

22

On Campus - Outpatient Hospital

23

Emergency Room-Hospital

24

Ambulatory Surgery Center (ASC)

26

Military Treatment Facility

31

Skilled Nursing Facility

34

Hospice

41

Ambulance - Land

42

Ambulance - Air or Water

51

Inpatient Psychiatric Hospital

52

Psychiatric Facility-Partial Hospitalization

53

Community Mental Health Center

56

Psychiatric Residential Treatment Center

61

Comprehensive Inpatient Rehabilitation Facility

(C) CORRECT REPORTING AND PAYMENT POLICIES:

(1) Providers shall report codes and number of units based on all applicable code descriptions and this Rule. In addition, providers shall document all services/ procedures in the medical record.

(2) Providers shall report the most comprehensive code that represents the entire service.

(3) Providers shall report only the primary services and not the services that are integral to the primary services.

(4) Providers shall document the time spent performing all time-based services or procedures in accordance with applicable code descriptions.

(5) Providers shall apply modifiers to clarify services rendered and/or adjust the maximum allowances as indicated in this Rule. When correcting a modifier, Payers shall comply with Rule 16.

Disclaimer: These regulations may not be the most recent version. Colorado may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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