Code of Colorado Regulations
1100 - Department of Labor and Employment
1101 - Division of Workers' Compensation
7 CCR 1101-3 Rule 18 - Rule 18, MEDICAL FEE SCHEDULE (Rule 18 exhibits published separately)
Section 7 CCR 1101-3-18-4 - PROFESSIONAL FEES AND SERVICES

Universal Citation: 1100 CO Code Regs 7 CCR 1101-3-18-4

Current through Register Vol. 47, No. 17, September 10, 2024

(A) GENERAL INSTRUCTIONS

(1) Conversion Factors (CFs):

Maximum allowances are determined by multiplying the following CFs by the established facility or non-facility total relative value units (RVUs) found in the corresponding RBRVS sections:

RBRVS SECTION

CF

Anesthesia

$44.00

Surgery/Radiology/Pathology/Medicine (SRPM)

$68.00

Physical Medicine and Rehabilitation

$49.00

(Includes Medical Nutrition Therapy and Acupuncture)

Evaluation & Management (E&M)

$56.00

(2) Maximum Allowance:
(a) Maximum allowance for most providers shall be 100% of the Medical Fee Schedule unless otherwise specified in this Rule.

(b) The maximum allowance for Physician Assistants (PAs) and Nurse Practitioners (NPs) shall be 85% of the Medical Fee Schedule. However, PAs and NPs are allowed 100% of the Medical Fee Schedule if the requirements of Rule 16 have been met and one of the following conditions applies:
(i) The service is provided in a rural area. Rural area means:

* a county outside a Metropolitan Statistical Area (MSA) or

* a Health Professional Shortage Area, located either outside of an MSA or in a rural census tract, as determined by the Office of Rural Health Policy, Health Resources and Services Administration, United States Department of Health and Human Services.

(ii) The PA or NP is Level I Accredited.

(c) The Payer may negotiate reimbursement of travel expenses not addressed in the fee schedule (including transit time) with providers traveling to a rural area to serve an injured worker. Rural area is defined in subsection (2)(b)(i) above. This reimbursement shall be in addition to the maximum allowance for services addressed in the fee schedule.

(3) The Division adopts the following RBRVS attributes or modifies them as follows:
(a) HCPCS (Healthcare Common Procedure Coding System) - including any CPT® codes, Level I (CPT®), and Level II (HCPCS) Modifiers (listed and unlisted).

(b) Description - short description as listed in the file and long description as specified in CPT®.

(c) Status Code:

Status

Meaning

A

Separately Payable

B & P

Bundled Code

C

Priced per Rule 16-10-1

E

HCPCS J0120 to J9999 and CPT® 90296-90750 are payable. HCPCS Q4074-Q4255 require prior authorization for payment.

All other codes are not payable unless otherwise specified in this Rule.

I

HCPCS A0021-A0998 and S0012-S0199 (see section 18-4(B)(6)(c)) are payable.

Dental codes are paid per Exhibit #3;

All other codes are not payable unless otherwise specified in this Rule. There may be another code for reporting and payment of these services.

J

Anesthesia Code

M & Q

Measurement or Functional Information Codes - No Value

N

HCPCS A4210-A9300 are payable when these supplies are issued for home use.

Dental codes are paid per Exhibit #3.

HCPCS V2025-V5290 are payable per section 18-6(A). There may be another code for reporting and payment of services associated with V-codes.

Codes found in the Medicine Section of CPT® with an assigned RBRVS value (section 18-2(A)) are payable.

All other codes are not payable unless otherwise specified in this Rule.

R

Dental codes are paid per Exhibit #3.

All other codes require prior authorization for payment unless otherwise specified in this Rule.

T

Paid When It Is the Only Payable Service Performed

X

Codes with an assigned RBRVS or DMEPOS value (section 18-2(A)) are payable.

All other codes are not payable unless otherwise specified in this Rule.

(d) Increment of Service/Billable (when specified).

(e) Anesthesia Base Unit(s), see section 18-4(C).

(f) Non-Facility (NF) Total RVUs.

(g) Facility (F) Total RVUs.

(h) Professional Component/Technical Component Indicators.

Indicator

Meaning

0

Physician Service Codes - professional component/ technical component (PC/TC) distinction does not apply.

1

Diagnostic Radiology Tests - may be billed with or without modifiers 26 or TC.

2

Professional Component Only Codes - standalone professional service code (no modifier is appropriate because the code description dictates the service is professional only).

3

Technical Component Only Codes - standalone technical service code (no modifier is appropriate because the code description dictates the service is technical only).

4

Global Test Only Codes - modifiers 26 and TC cannot be used because the values equal to the sum of the total RVUs (work, practice expense, and malpractice).

5

Incident To Codes - do not apply.

6

Laboratory Physician Interpretation Codes - separate payments may be made (these codes represent the professional component of a clinical laboratory service and cannot be billed with modifier TC).

7

Physical Therapy Service - not recognized.

8

Physician Interpretation Codes - separate payments may be made only if a physician interprets an abnormal smear for a hospital inpatient.

9

Concept of PC/TC distinction does not apply.

(i) Global Days: a period of time starting with the preoperative period of a surgical procedure and ending some period of time after the procedure was performed.

Indicator

Meaning

000

Endoscopies or some minor surgical procedures, typically a zero day post-operative period. E&M visits on the same day as procedures generally are included in the procedure, unless a separately identifiable service is reported with an appropriate modifier.

010

Other minor procedures, 10-day post-operative period. E&M visits on the same day as procedures and during the 10-day post-operative period generally are included in the procedure, unless a separately identifiable service is reported with an appropriate modifier.

090

Major surgeries, 90-day post-operative period. E&M visits the day before and on same day as procedures, as well as during the 90-day post-operative period generally are included in the procedure, unless a separately identifiable service is reported with an appropriate modifier.

MMM

Global service days concept does not apply (see Medicare's Global Maternity Care reporting rule).

XXX

Global concept does not apply.

YYY

Identifies primarily "BR" procedures where "global days" need to be determined by the Payer.

ZZZ

Code is related to another service and always included in the global period of the other service. Identifies "add-on" codes.

(j) Pre-Operative Percentage Modifier: percentage of the global surgical package payable when pre-operative care is rendered by a provider other than the surgeon.

Indicator

Meaning

%

The physician shall append modifier 56 when performing only the pre-operative portion of any surgical procedure. This modifier can be combined with either modifier 54 or 55, but not both. This column lists the allowed percentage of the total surgical relative value unit.

(k) Intra-Operative Percentage Modifier: percentage of the global surgical package payable when the surgeon renders only intra-operative care.

Indicator

Meaning

%

The surgeon shall append modifier 54 when performing only the intra-operative portion of a surgical procedure. This modifier can be combined with either modifier 55 or 56, but not both. This column lists the allowed percentage of the total surgical relative value unit.

(l) Post-Operative Percentage Modifier: percentage of the global surgical package payable when post-operative care is rendered by a provider other than the surgeon.

Indicator

Meaning

%

The surgeon shall append modifier 55 when performing only the post-operative portion of a surgical procedure. This modifier can be combined with either modifier 54 or 56, but not both. This column lists the allowed percentage of the total surgical relative value unit.

(m) Multiple Procedure Modifier: the maximum allowance for the highest-valued procedure is 100% of the fee schedule, even if the provider appends modifier 51. The maximum allowance for the lesser-valued procedures performed in the same operative setting is 50% of the fee schedule.

Indicator

Meaning

0

No payment adjustment for multiple procedures applies. These codes are generally identified as "add-on" codes in CPT®.

1, 2, or 3

Standard payment reduction applies (100% for the highest-valued procedure and 50% for all lesser-valued procedures performed during the same operative setting).

4, 5, 6, or 7

Not subject to the multiple procedure adjustments.

9

Multiple procedure concept does not apply.

(n) Bilateral Procedure Modifier.

Indicator

Meaning

0

Not eligible for the bilateral payment adjustment. Either the procedure cannot be performed bilaterally due to the anatomical constraints or another code more adequately describes the procedure.

1

Eligible for bilateral payment adjustment and shall be reported on one line with modifier 50 and "1" in the units box.

Providers performing the same bilateral procedure during the same operative setting on multiple sites shall report the second and subsequent procedures with modifiers 50 and 59. Report on one line with one unit for each bilateral procedure performed. The maximum allowance is increased to 150%.

If provider performs multiple bilateral procedures during the same setting, Payer shall apply the bilateral payment adjustment rule first, and then apply other applicable payment adjustments (e.g., multiple surgery).

2

Not eligible for the bilateral payment adjustment. These procedure codes are already bilateral.

3

Not eligible for the bilateral payment adjustment. Report these codes on two lines with RT and LT modifiers. There is one payment per line.

9

Not eligible for the bilateral payment adjustment because the concept does not apply.

(o) Assistant Surgeon, Modifiers 80, 81, 82, or AS: the designation of "almost always" for a surgical code in the Physicians as Assistants at Surgery: 2023 Update (February 2023), published by the American College of Surgeons shall indicate that separate payment for an assistant surgeon is allowed for that code. If that publication does not make a recommendation on a surgical code or lists it as "sometimes" or "almost never," then RBRVS indicators shall determine whether separate payment for assistant surgeons is allowed.

Indicator

Meaning

0

Documentation of medical necessity and prior authorization is required to allow an assistant at surgery.

1

No assistant at surgery is allowed.

2

Assistant at surgery is allowed.

9

Concept does not apply.

No separate assistant surgeon or minimum assistant fees shall be paid if a co-surgeon is paid for the same operative procedure during the same surgical episode. See section 18-4(D)(1) for additional payment policies.

(p) Co-Surgeon, Modifier 62.

Indicator

Meaning

1 or 2

Indicators may require two primary surgeons performing two distinct portions of a procedure. Modifier 62 is used with the procedure and maximum allowance is increased to 125% of the fee schedule value.

The payment is apportioned to each surgeon in relation to the individual responsibilities and work, or it is apportioned equally between the co-surgeons.

0 or 9

Not eligible for co-surgery fee allowance adjustment. These procedures are either straightforward or only one surgeon is required, or the concept does not apply.

(q) Team Surgeon, Modifier 66.

Indicator

Meaning

0

Team surgery adjustments are not allowed.

1

Prior authorization is required for team surgery adjustments.

2

Team surgery adjustments may occur as a "BR." Each team surgeon must bill modifier 66. Payer must adjust the values in consultation with the billing surgeon(s).

9

Concept does not apply.

(r) Endoscopy base codes are not recognized for payment adjustments except when other modifiers apply.

(s) All other fields are not recognized.

(B) EVALUATION AND MANAGEMENT (E&M)

(1) E&M codes may be billed by Physicians, NPs, and PAs, as defined in Rule 16. To justify the billed level of E&M service, medical records shall utilize CPT® E&M Services Guidelines and Exhibit #1 for office or other outpatient services.

To justify the level of E&M service billed based on time, the provider shall not count the time spent on other reportable codes.

(2) New or Established Patients:

An E&M visit shall be billed as a "new" patient service for each new injury or new Colorado workers' compensation claim even if the provider has seen the injured worker within the last three years.

Any subsequent E&M visits for the same injury billed by the same provider or another provider of the same specialty or subspecialty in the same group practice shall be billed as an "established patient" visit.

Transfer of care from one physician to another with the same tax ID and specialty or subspecialty shall be billed as an "established patient" regardless of location.

(3) Number of Office Visits:

All providers are limited to one office visit per injured worker, per day, per workers' compensation claim, unless prior authorization is obtained.

(4) Treating Physician Telephone or On-line Services: Minimum required documentation elements include:
(a) Total time spent on medical discussion and date;

(b) The injured worker, family member, or healthcare provider spoken with; and

(c) Specific discussion and/or decision(s) made during the discussion.

Telephone or on-line services may be billed even if performed within the one day and seven day timelines listed in CPT®.

(5) Consultation/Referrals/Transfers of Care/Independent Medical Examinations:

A consultation occurs when a treating Physician seeks an opinion from another

Physician regarding an injured worker's diagnosis and/or treatment beyond the treating Physician's expertise. CPT® 99242-99245 are payable codes.

To bill for a consultation, the Physician must document the following:

(a) Identity of the Physician requesting the opinion;

(b) The need for a consultant's opinion;

(c) Statement that the report was submitted to the requesting Physician.

A transfer of care occurs when one Physician turns over the responsibility for the comprehensive care of an injured worker to another Physician.

An independent medical exam (IME) occurs when a Physician is requested to evaluate an injured worker by any party or party's representative and is billed in accordance with section 18-7(G).

(6) Prolonged Services:

Providers shall document the medical necessity of prolonged services utilizing patient-specific information. Providers shall comply with all applicable CPT® requirements and the following additional requirements.

(a) Physicians or other qualified healthcare professionals (MDs, DOs, DCs, DMPs, NPs, and PAs) billing for extensive record review shall document the names of providers and dates of service reviewed, as well as briefly summarize each record reviewed.

(b) Prolonged clinical staff services (RNs or LPNs) with physician or other qualified healthcare professional supervision:
(i) The supervising physician or other qualified healthcare professional may not bill for the time spent supervising clinical staff.

(ii) Clinical staff services cannot be provided in an urgent care or emergency department setting.

(c) Providers shall bill the CPT® code for prolonged services.

CPT® 99417

Non-facility RVU is .92, facility RVU is .89

CPT® 99418

Non-facility and facility RVUs are 1.16

(C) ANESTHESIA

(1) All anesthesia base values are set forth in Medicare's Anesthesia Base Units by CPT® code, as incorporated by section 18-2. Anesthesia services are only reimbursable if the anesthesia is administered by a Physician, a Certified Registered Nurse Anesthetist (CRNA), or an Anesthesiologist Assistant (AA) who remains in constant attendance during the procedure for the sole purpose of rendering anesthesia.

When a CRNA or AA administers anesthesia:

(a) CRNAs not under the medical direction of an Anesthesiologist shall be reimbursed 90% of the maximum anesthesia value;

(b) If billed separately, CRNAs and AAs under the medical direction of an Anesthesiologist shall be reimbursed 50% of the maximum anesthesia value. The other 50% is payable to the Anesthesiologist providing the medical direction to the CRNA or AA;

(c) Medical direction for administering anesthesia means the Anesthesiologist performs the following:
(i) examines and evaluates the injured worker before administering anesthesia;

(ii) prescribes the anesthesia plan;

(iii) personally participates in the most demanding procedures in the anesthesia plan including, if applicable, induction and emergence;

(iv) ensures that any procedure in the anesthesia plan is performed by a qualified anesthetist;

(v) monitors anesthesia administration at frequent intervals;

(vi) remains physically present and available for immediate diagnosis and treatment of emergencies; and

(vii) provides indicated post-anesthesia care.

(2) HCPCS Level II modifiers are required when billing for anesthesia services. Modifier AD shall be used when an Anesthesiologist supervises more than four concurrent (occurring at the same time) anesthesia service cases. Maximum allowance for supervising multiple cases is calculated using three base anesthesia units for each case, regardless of the number of base anesthesia units assigned to each specific anesthesia episode of care.

(3) Physical status modifiers are reimbursed as follows, using the Anesthesia CF:

P-1

Healthy patient

0 RVUs

P-2

Patient with mild systemic disease

0 RVUs

P-3

Patient with severe systemic disease

1 RVU

P-4

Patient with severe systemic disease that is a constant threat to life

2 RVUs

P-5

A moribund patient who is not expected to survive without the operation

3 RVUs

P-6

A declared brain-dead patient whose organs are being removed for donor purposes

0 RVUs

(4) Qualifying circumstance codes are reimbursed using the Anesthesia CF:

Anesthesia complicated by extreme age (under one or over 70 yrs)

1 RVU

Anesthesia complicated by utilization of total body hypothermia

5 RVUs

Anesthesia complicated by utilization of controlled hypotension

5 RVUs

Anesthesia complicated by emergency conditions (specify)

2 RVUs

(5) Multiple procedures are billed in accordance with CPT®. When more than one surgical procedure is performed during a single episode, only the highest-valued base anesthesia procedure value is added to the total anesthesia time for all procedures.

(6) Total minutes are reported for reimbursement. Each 15 minutes of anesthesia time equals one additional RVU. Five minutes or more is considered significant time and adds one RVU to the payment calculation.

(7) Calculation of Maximum Allowance for Anesthesia:
(a) Add the anesthesia base units, one unit for each 15 minutes of anesthesia time, and any physical status modifier units to calculate total relative value anesthesia units;

(b) Multiply the total relative value anesthesia units by the Anesthesia CF to calculate the total maximum anesthesia allowance.

(8) Non-time based anesthesia procedures shall be billed with modifier 47. (D) SURGERY
(1) Assistant Surgeons Payment Policies and Modifiers:
(a) The use of assistant surgeons shall be limited according to the American College of Surgeons' Physicians as Assistants at Surgery: 2023 Update (February 2023), available from the American College of Surgeons, Chicago, IL, or from its web page.

Provider shall document the medical necessity for any assistant surgeon in the operative report.

(b) Payment for more than one assistant surgeon or minimum assistant surgeon requires prior authorization.

(c) Maximum allowance for an assistant surgeon reported by a physician, as indicated by modifier 80, 81, or 82 is 20% of the fee schedule allowance.

(d) Maximum allowance for a minimum assistant surgeon, reported by a non-physician, as indicated by modifier AS is 10% of the fee schedule allowance (the 85% adjustment in section 18-4(A)(2)(b) does not apply).

(e) The services performed by registered surgical technologists are bundled fees and are not separately payable.

See section 18-4(A)(3) for additional payment policies applicable to assistant surgeons.

(2) Global Package:
(a) Global surgical package rules apply in any setting, including inpatient and outpatient hospitals, ambulatory surgical centers, and physicians' offices. The payment rules for global surgical packages apply to surgical procedure codes with global surgery indicators of 000, 010, 090, and sometimes YYY. In addition to the services included pursuant to CPT®, the following services, when provided within the global period by a provider with the same specialty reporting the same Federal Employer Identification Number (FEIN), are included in the global surgical package:
(i) Pre-operative services performed within the global period (the day before surgery for procedures with global surgery indicators of 090, and the day of the surgery for all other procedures);

(ii) Complications following a procedure that require services of the physician, but not a return trip to the operating room;

(iii) Post-operative visits, including follow-up E&Ms, related to the patient recovery;

(iv) Post-surgical pain management;

(v) Supplies related to the procedure, unless otherwise addressed in this Rule;

(vi) Miscellaneous services related to the procedure such as dressing changes; local incision care; removal of operative pack; removal of cutaneous sutures, staples, lines, wires, tubes, drains, casts, and splints; insertion, irrigation, and removal of urinary catheters, routine peripheral intravenous lines, and nasogastric and rectal tubes; and changes/removal of tracheostomy tubes.

(b) Services not included in the global surgical package:
(i) Services by a provider who is not the same specialty unless the surgeon and the other provider agree on the transfer of care (for transfers of care, see pre-, intra-, and post- operative percentage modifiers);

(ii) The E&M service that resulted in the initial decision to perform the surgery. billed with modifier 57;

(iii) Visits that are unrelated to the diagnosis for which the procedure was performed, billed with modifier 24 or 25;

(iv) Diagnostic tests and procedures (including lab and x-ray);

(v) Staged or related procedures or services that occur on the same day or staged over a couple of days, billed with modifier 58. The maximum allowance is 100% of the fee schedule.

(vi) Clearly distinct procedures during the post-operative period that are not re-operations or treatment for complications;

(vii) Treatment for post-operative complications requiring a return trip to the operating room or another place of service specifically equipped and staffed for the sole purpose of performing procedures, billed with modifier 78. The maximum allowance is the intra-operative value of the procedure(s) performed only and the original post-operative global days continue from the initial surgical procedure(s).

(viii) Increased procedural services (the work required to provide a service is substantially greater than typically required), billed with modifier 22. The Payer and Provider shall negotiate the value based on the fee schedule and the amount of additional work.

(ix) Significant and separately identifiable services, billed with modifier 24 or 25. These services are not considered part of the surgical procedure, but may be necessary to stabilize the patient for the procedure. These services may involve unusual circumstances, complications, exacerbations, or recurrences; and/or unrelated diseases or injuries. This category also includes an E&M visit by an ATP for disability management. Disability management for the same diagnosis requires the physician to identify specific disability management detail performed during that visit.

(x) Casting supplies if a related fracture or surgical care code is not billed. The HCPCS Level II "Q" code(s) are used for reporting any associated DMEPOS fees.

(xi) Immunosuppressive therapy for organ transplants.

(3) General Surgical Payment Policies:
(a) Exploration of a surgical site is not separately payable except in cases of a traumatic wound or an exploration performed in a separate anatomic location.

(b) An arthroscopy performed as a "scout" procedure to assess the surgical field or extent of disease is bundled into the surgical procedure performed on the same body part during the same surgical encounter and is not separately payable.

(c) An arthroscopy converted to an open procedure is bundled into the open procedure and is not separately payable. In this circumstance, providers shall not report either a surgical arthroscopy or a diagnostic arthroscopy code.

(d) Only the joints/compartments listed in subsections (4) through (6) below are recognized for separate payment purposes.

(e) Providers shall report only one removal code for removal of implants through the same incision, same anatomical site, or a single implant system during the same episode of care.

(4) Knee Arthroscopies:
(a) Medial, lateral, and patella are the knee compartments recognized for purposes of separate payment of debridement and synovectomies.

(b) Chondroplasty is separately payable with another knee arthroscopy only if performed in a different knee compartment or to remove a loose/foreign body during a meniscectomy. The separate payment must comply with all applicable CPT® guidelines.

(c) Limited synovectomy involving one knee compartment is not separately payable with another arthroscopic procedure on the same knee.

(d) Separate payment for a major synovectomy procedure requires a synovial diagnosis and two or more knee compartments without any other arthroscopic surgical procedures performed in the same compartment.

(5) Shoulder Arthroscopies:

CPT® 29822 is not separately payable when another shoulder arthroscopy procedure is billed and paid on the same shoulder at the same encounter. CPT® 29823 is bundled with CPT® 29806 and 29807.

(6) Spine and Nervous System:
(a) Spinal manipulation is integral to spinal surgical procedures and is not separately payable.

(b) Surgeon performing a spinal procedure shall not report intra-operative neurophysiology monitoring/testing codes.

(c) If multiple procedures from the same CPT® code family are performed at contiguous vertebral levels, provider shall append modifier 51 to all lesser-valued primary codes. See section 18-4(A)(3) for applicable payment policies.

(d) Fluoroscopy is separately payable with spinal procedures only if indicated by a specific CPT® instruction.

(e) Lumbar laminotomies and laminectomies performed with arthrodesis at the same interspace are separately payable if the surgeon identifies the additional work performed to decompress the thecal sac and/or spinal nerve(s). If these procedures are performed at the same level, provider shall append modifier 51 to the lesser-valued procedure(s). If procedures are performed at different interspaces, provider shall append modifier 59 to the lesser-valued procedure(s). See section 18-4(A)(3) for applicable payment policies.

(f) Only one anterior or posterior instrumentation performed through a single skin incision is payable.

(g) Anterior instrumentation performed to anchor an inter-body biomechanical device to the intervertebral disc space is not separately payable.

(h) Anterior instrumentation unrelated to anchoring the device is separately payable with modifier 59 appended.

(7) Venipuncture maximum fee allowance is addressed in section 18-4(F)(2).

(8) Platelet Rich Plasma (PRP) Injections:

The maximum allowance includes and applies to all body parts, imaging guidance, harvesting, preparation, the injection itself, kits, and supplies.

CPT® 0232T

Non-facility RVU is 11.16, facility RVU is 4.04

(9) Functional Assessments:

If all requirements of the Medical Treatment Guidelines for pre- and post- injection functional assessments have been met and documented, the billing codes and maximum allowances are as follows:

DOWC Z0811, $64.26, per episode for the initial functional assessment of pre-injection care, related to spinal or SI joint injections (may be performed by injectionist or non-injectionist no more than seven days prior to the injection).

DOWC Z0812, $35.29, for a subsequent visit of therapeutic post-injection care (preferably done by a non-injectionist and at least seven days after the injection), billed along with the appropriate E&M code, related to follow-up care of spinal or SI joint injections. The injured worker should provide post injection data.

DOWC Z0814, $35.29, for post-diagnostic injection care (repeat functional assessment within the time period for the effective agent given).

(E) RADIOLOGY

(1) Payments:
(a) The Division recognizes the value of accreditation for quality and safe radiological imaging. Only offices/facilities that have attained accreditation from American College of Radiology (ACR), Intersocietal Accreditation Commission (IAC), RadSite, or The Joint Commission (TJC) may bill the technical component for Advanced Diagnostic Imaging (ADI) procedures (magnetic resonance imaging (MRI), computed tomography (CT), and nuclear medicine scan). Providers reporting technical or total component of these services certify accreditation status. The provider shall supply proof of accreditation upon Payer request.

(b) The cost of dye and contrast materials shall be reimbursed in accordance with section 18-6(A).

(c) Copying charges for X-rays and MRIs shall be $15.00/film regardless of the size of the film.

(d) Providers using film instead of digital X-rays shall append the FX modifier.

The allowance is 80% of the Maximum Fee Schedule.

If a physician interprets the same radiological image more than once, or if multiple physicians interpret the same radiological image, only one interpretation shall be reimbursed.

If an X-ray consultation is requested, the consultant's report shall include the name of the requesting provider, the reason for the request, and documentation that the report was sent to the requesting provider.

The maximum allowance for an X-ray consultation shall be no greater than the maximum allowance for the professional component of the original X-ray.

The time a physician spends reviewing and/or interpreting an existing radiological image is considered a part of the physician's E&M service code.

(2) Thermography:
(a) The provider supervising and interpreting the thermographic evaluation shall be certified by the examining board of one of the following national organizations and follow their recognized protocols, or have equivalent documented training:
(i) American Academy of Thermology;

(ii) American Chiropractic College of Infrared Imaging; or

(iii) American Academy of Infrared Imaging.

(b) Thermography Billing Codes:

DoWC Z0200 Upper Body w/ Autonomic Stress Testing

$980.00

DoWC Z0201 Lower Body w/Autonomic Stress Testing

$980.00

(c) Documentation must include:
(i) Method of stress thermography supporting it was accomplished in a guideline-consistent fashion (cold water stress test, warm water stress test, or whole body thermal stress);

(ii) Temperature readings via infrared thermography and their locations on the affected and contralateral extremity and/or copies of any pictures or graphics obtained; and

(iii) Interpretation of the results.

(F) PATHOLOGY

(1) Clinical Laboratory Improvement Amendments (CLIA):

Only laboratories with a CLIA certificate of waiver may perform tests cleared by the Food and Drug Administration (FDA) as waived tests. Laboratories with a CLIA certificate of waiver, or other providers billing for services performed by these laboratories, shall bill using the QW modifier.

Laboratories with a CLIA certificate of compliance or accreditation may perform non- waived tests. Laboratories with a CLIA certificate of compliance or accreditation, or other providers billing for services performed by these laboratories, do not append the QW modifier.

(2) Payments:

All clinical pathology laboratory tests, except as allowed by this Rule, are reimbursed at 170% of the rate listed in the CMS Clinical Diagnostic Laboratory Fee Schedule, as incorporated by section 18-2.

Technical or professional component maximum split is not separately payable, and therefore should be negotiated between billing parties when applicable.

When a physician clinical pathologist is required for consultation and interpretation, and a separate written report is created, the maximum allowance is determined by using RBRVS values and the Pathology CF. The Pathology CF also determines the maximum allowance when the Pathology CPT® code description includes "interpretation" and "report" or when billing CPT® codes for the following services:

(a) physician blood bank services;

(b) cytopathology and cell marker study interpretations;

(c) cytogenics or molecular cytogenics interpretation and report;

(d) surgical pathology gross and microscopic and special stain groups 1 and 2 and histochemical stain, blood or bone marrow interpretations; and

(e) skin tests for unlisted antigen each, coccidoidomycosis, histoplasmosis, TB intradermal.

When ordering automated laboratory tests, the ordering physician may seek verbal consultation with the pathologist in charge of the laboratory's policy, procedures and staff qualifications. The consultation with the ordering physician is not payable unless the physician requested additional medical interpretation, judgment, and a separate written report. Upon such a request, the pathologist may bill using the appropriate CPT® code, not DoWC Z0755.

The maximum allowance for CPT® 80050 is $39.95 (equal to the total allowance for CPT® 80053, 85004, and 85027).

(3) Clinical Drug Screening and Testing:

Clinical drug screening and testing may be appropriate for therapeutic drug monitoring, to assess compliance, or to identify illicit or non-prescribed drug use.

(a) Billing requirements for clinical drug testing:
(i) documentation of medical necessity by the ordering Physician.

(ii) the ordering Physician shall specify which drugs require definitive testing to meet the injured worker's medical needs.

(iii) a Physician order for quantification of illicit or non-prescribed drugs or drug classes.

(b) Presumptive Tests:

All drug class immunoassays or enzymatic methods are considered presumptive. Payers shall only pay for one presumptive test per date of service, regardless of the number of drug classes tested.

(c) Definitive qualitative or quantitative tests identify specific drug(s) and any associated metabolites, providing sensitive and specific results expressed as a concentration in ng/mL or as the identity of a specific drug.

* These tests may be billed using G0480-G0483.

* Providers may only bill one definitive HCPCS Level II code per day.

A Physician must order definitive quantitative tests. The reasons for ordering a definitive quantification drug test may include:

* Unexpected positive presumptive or qualitative test results inadequately explained by the injured worker.

* Unexpected negative presumptive or qualitative test results and suspected medication diversion.

* Differentiate drug compliance:

* Buprenorphine vs. norbuprenorphine

* Oxycodone vs. oxymorphone and noroxycodone

* Need for quantitative levels to compare with established benchmarks for clinical decision-making, such as tetrahydrocannabinol quantitation to document discontinuation of a drug.

* Chronic opioid management:

* Drug testing shall be done prior to the implementation of the initial long-term drug prescription and randomly repeated at least annually.

* While the injured worker receives chronic opioid management, additional drug screens with documented justification may be conducted (see section 18-9(A) for examples).

CPT® lists definitive drug classes and examples of individual drugs within each class. Each class of drug can only be billed once per day.

(G) MEDICINE

(1) Biofeedback:

Licensed medical and mental health professionals who provide biofeedback must practice within the scope of their training. Non-licensed biofeedback providers must hold Clinical Certification from the Biofeedback Certification International Alliance (BCIA), practice within the scope of their training, and receive prior approval of their biofeedback treatment plan from the injured worker's authorized treating Physician, or Psychologist. Professionals integrating biofeedback with any form of psychotherapy must be a Psychologist, a Clinical Social Worker, a Marriage and Family Therapist, or a Professional Counselor.

All biofeedback providers shall document biofeedback instruments used during each visit (including, but not limited to, surface electromyography (SEMG), heart rate variability (HRV), electroencephalogram (EEG), or temperature training), placement of instruments, and patient response if sufficient time has passed.

The modified RVUs for biofeedback are:

CPT® 90901

Non-facility RVU is 1.78, facility RVU is 1.76

CPT® 90875

Non-facility RVU is 2.13, facility RVU is 1.82

Psychophysiological therapy incorporating biofeedback is not subject to a reduction when performed by non-physician providers.

(2) Appendix J of CPT® identifies mixed, motor, and sensory nerve conduction studies and applicable billing requirements. For purposes of Appendix J, each nerve branch listed in that appendix counts as a separate nerve. Electromyography (EMG) and nerve conduction velocity values generally include an E&M service. However, an E&M service may be separately payable if the requirements listed in Appendix A of CPT® for billing modifier 25 have been met.

(3) Manipulation -- Chiropractic (DC), Medical (MD) and Osteopathic (DO):
(a) Prior authorization shall be obtained before billing for more than four body regions in one visit.

(b) Osteopathic Manipulative Treatment and Chiropractic Manipulative Treatment codes include manual therapy techniques, unless the Physician performs manual therapy in a separate region and meets modifier 59 requirements.

(c) The modified RVUs for chiropractic spinal manipulative treatment are:

CPT® 98940

Non-facility RVU is 1.03, facility RVU is 0.81

CPT® 98941

Non-facility RVU is 1.48, facility RVU is 1.26

(4) Psychiatric/Psychological Services:
(a) The maximum allowance for services performed by a Psychologist is 100% of the Medical Fee Schedule. The maximum allowance for psychological/ psychiatric services performed by other non-physician providers is 85% of the Medical Fee Schedule.

(b) Psychological diagnostic evaluation code(s) are limited to one per provider, per admitted claim, unless it is authorized by the Payer or is necessary to complete an impairment rating recommendation as determined by the ATP.

(c) Central Nervous System (CNS) Assessments/Tests:

When testing, evaluation, administration, and scoring services are provided across multiple dates of service, all codes should be billed on the last date of service when the evaluation process is completed. A base code shall be billed only for the first unit of service of the evaluation process, and add-on codes shall be used to capture services provided during subsequent dates of service. The limit for these services is 16 hours unless the provider obtains prior authorization.

Documentation shall include the total time and the approximate time spent on each of the following activities, when performed:

* face-to-face time with the patient;

* reviewing and interpreting standardized test results and clinical data;

* integrating patient data;

* clinical decision-making and treatment planning;

* report preparation.

If there is a delay in scheduling the feedback session, the provider may incorporate feedback into the first psychotherapy session.

The modified RVUs for psychological and neuropsychological services are:

CPT® 96116

Non-facility RVU is 3.50, facility RVU is 3.07

CPT® 96127

Non-facility and facility RVUs are 0.19

CPT® 96130

Non-facility RVU is 3.74, facility RVU is 3.50

CPT® 96131

Non-facility RVU is 3.00, facility RVU is 2.81

CPT® 96132

Non-facility RVU is 4.23, facility RVU is 3.29

CPT® 96133

Non-facility RVU is 3.20, facility RVU is 2.51

CPT® 96146

Non-facility and facility RVUs are 0.10

CPT® 90791

Non-facility RVU is 10.2, facility RVU is 8.80

CPT® 90792

Non-facility RVU is 11.45, facility RVU is 10.3

(d) The limit for psychotherapy services is 60 minutes per visit, unless the Provider obtains prior authorization. The time for internal record review/ documentation is included in this limit.

Psychotherapy for work-related conditions continuing for more than three months after the initiation of therapy requires prior authorization unless the MTGs recommend a longer duration.

(e) When billing an E&M code in addition to psychotherapy:
(i) both services must be separately identifiable;

(ii) the level of E&M must be based on history, exam, and medical decision- making;

(iii) time may not be used as the basis for the E&M code selection; and

(iv) the Provider must use add-on psychotherapy codes to indicate both services were provided.

Non-medical disciplines cannot bill most E&M codes.

(f) A Provider billing for any stored clinical or physiological data analysis must obtain prior authorization.

(g) Upon request of a party to a workers' compensation claim and pursuant to HIPAA regulations, a psychiatrist, psychologist or other qualified healthcare professional may generate a separate report and bill for that service as a special report.

(5) Telephone or On-Line Services:

Reimbursement for coordination of care between medical professionals is limited to professionals outside of the Provider's practice.

Telephone services, including those listed in Appendix T and Telephone Services section of CPT®, shall be billed with a modifier 93.

The modified RVUs for the telephone and on-line services are:

CPT® 99421

Non-facility and facility RVUs are 0.38

CPT® 99422

Non-facility and facility RVUs are 0.75

CPT® 99423

Non-facility and facility RVUs are 1.19

CPT® 99441

Non-facility and facility RVUs are 1.03

CPT® 99442

Non-facility and facility RVUs are 1.95

CPT® 99443

Non-facility and facility RVUs are 2.86

CPT® 98966

Non-facility and facility RVUs are 0.27

CPT® 98967

Non-facility and facility RVUs are 0.53

CPT® 98968

Non-facility and facility RVUs are 0.75

For reimbursement of face-to-face or telephonic meetings by a treating Physician or Psychologist with employer, claim representative, or attorney, see section 18-7(A)(1).

(6) Quantitative Autonomic Testing Battery (ATB) and Autonomic Nervous System Testing:
(a) Quantitative Sudomotor Axon Reflex Test (QSART) is a diagnostic test used to diagnose Complex Regional Pain Syndrome. This test is performed on a minimum of two extremities and encompasses the following components:
(i) Resting Sweat Test;

(ii) Stimulated Sweat Test;

(iii) Resting Skin Temperature Test; and

(iv) Interpretation of clinical laboratory scores. Physician must evaluate the patient specific clinical information generated from the test and quantify it into a numerical scale. The data from the test and a separate report interpreting the results of the test must be documented.

(b) DoWC Z0401 QSART, $1,066.00, is billed when all of the services outlined above are completed and documented. This code may only be billed once per workers' compensation claim, regardless of the number of limbs tested.

(7) Intra-Operative Monitoring (IOM):

IOM identifies compromise to the nervous system during certain surgical procedures. Evoked responses are constantly monitored for changes that could imply damage to the nervous system.

(a) Clinical Services:
(i) Technical staff: A qualified technician shall set up the monitoring equipment in the operating room. The technician shall be in constant attendance in the operating room with the physical or electronic capacity for real-time communication with the supervising neurologist or other physician trained in neurophysiology. The technician shall be specifically trained in/registered with:

* the American Society of Neurophysiologic Monitoring; or

* the American Society of Electrodiagnostic Technologists

(ii) Professional/Supervisory/Interpretive:

A Colorado-licensed Physician trained in neurophysiology shall monitor the patient's nervous system throughout the surgical procedure. The monitoring Physician's time is billed based upon the actual time the Physician devotes to the individual patient, even if the Physician is monitoring more than one patient. The monitoring Physician's time does not have to be continuous for each patient and may be cumulative. The Physician shall not monitor more than three surgical patients at one time. The Physician shall provide constant neuromonitoring at critical points during the surgical procedure as indicated by the surgeon or any unanticipated testing responses. There must be a neurophysiology-trained Colorado licensed Physician backup available to continue monitoring the other two patients if one of the patients being monitored has complications and/or requires the monitoring Physician's undivided attention. There is no additional payment for the back-up neuro-monitoring Physician, unless utilized.

(b) Procedures and Time Reporting:

Physicians shall include an interpretive written report for all primary billed procedures.

(c) Billing Restrictions:

Intra-operative neurophysiology codes do not have separate professional and technical components. However, certain tests performed in conjunction with these services have separate professional and technical components, which may be separately payable if documented and otherwise allowed in this Rule.

The neuromonitoring Physician is the only party allowed to report these codes.

The maximum allowance for CPT® 95941 is equal to the maximum allowance for CPT® 95940.

(8) Speech-language therapy/pathology or any care rendered under a speech-language therapy/pathology plan of care shall be billed with a GN modifier.

(9) Hearing and vision services are separately payable with a code from the Medicine Section of CPT®, in addition to the supplies payable per section 18-6(A)(1)(f). The maximum allowances for the following codes are as follows:

CPT® 92590

Non-facility value is $165.90, facility value is $93.80

CPT® 92591

Non-facility value is $248.78, facility value is $140.56

CPT® 92592

Non-facility value is $60.31, facility value is $34.07

CPT® 92593

Non-facility value is $90.46, facility value is $51.11

CPT® 92594

Non-facility value is $60.31, facility value is $34.07

CPT® 92595

Non-facility value is $90.46, facility value is $51.11

(10) Vaccines, toxoids, immune globulins (including those with status "I"), serums, or recombinant products shall be billed using the appropriate J code or CPT® code listed in the Medicare Part B Drug Average Sale Price (ASP), as incorporated by Rule 18-2, unless the ASP value does not exist for the drug or the provider's actual cost exceeds the ASP. In these circumstances, the provider may request reimbursement based on the actual cost, after taking into account any discounts/rebates the provider may have received.

The maximum allowance for CPT® 90371 is $800.

(11) IV infusion therapy performed in a Physician's office or sent home with the injured worker shall be billed under the "Therapeutic, Prophylactic, and Diagnostic Injections and Infusions" and the "Chemotherapy and Other Highly Complex Drug or Highly Complex Biologic Agent Administration" in the Medicine Section of CPT®. The maximum allowance for infused therapeutic drugs shall be at cost to the billing provider.

Maximum allowance for supplies and medications provided by a Physician's office for self-administered home care infusion therapy are covered in section 18-6(B).

(12) Moderate (Conscious) Sedation:

Providers billing for moderate sedation services shall comply with all applicable CPT® billing instructions. The maximum allowance is determined using the Medicine CF.

(H) PHYSICAL MEDICINE AND REHABILITATION (PM&R)

(1) General Policies:
(a) Modifiers:
(i) Physical therapy or any care provided under a Physical Therapist's plan of care shall be billed with a GP modifier. Occupational therapy or any care provided under an Occupational Therapist's plan of care shall be billed with a GO modifier.

(ii) Services provided in whole or in part by a Physical Therapist

Assistant shall be billed with a CQ modifier. Services provided in whole or in part by an Occupational Therapist Assistant shall be billed with a CO modifier. "In part" is defined as exceeding the CPT® mid-point. The CQ and CO modifiers shall be billed in addition to the GP or GO modifiers.

(b) Each PM&R billed service must be clearly identifiable. The provider must clearly document the time spent performing each service and the beginning and end time for each session.

(c) Functional objectives shall be included in the PM&R plan of care for all injured workers. Any request for additional treatment must be supported by evidence of positive objective functional gains or PM&R treatment plan changes. The ordering ATP must also agree with the PM&R continuation or changes to the treatment plan.

(d) The injured worker shall be re-evaluated by the prescribing provider within 30 calendar days from the initiation of the prescribed treatment and at least once every month thereafter.

(2) Medical nutrition therapy requires prior authorization.

(3) Interdisciplinary Rehabilitation Programs:

As defined in the MTGs, interdisciplinary rehabilitation programs may include, but are not limited to: chronic pain, spinal cord, or brain injury programs.

All billing providers shall detail the services, frequency of services, duration of the program, and proposed fees for the entire program. The billing Provider and Payer shall attempt to agree upon billing code(s) and fee(s) for each interdisciplinary rehabilitation program.

If there is a single billing provider for the entire interdisciplinary rehabilitation program and a daily per diem rate is mutually agreed upon, use code Z0500.

Individual professionals billing separately for their participation in an interdisciplinary rehabilitation program shall use the applicable CPT® codes.

(4) Procedures and Modalities:
(a) Definitions:
(i) Procedure is any treatment listed in the Medicine/Physical

Medicine and Rehabilitation section of CPT® under the subheading "Therapeutic Procedures." For purposes of this rule, the term "procedure" includes acupuncture.

The billing maximums listed below are per discipline per day, unless medical necessity is documented and prior authorization is obtained. The total amount of time spent performing the procedures shall determine the appropriate number of time based units for a particular visit.

(ii) Modality is any treatment listed in the Medicine/Physical Medicine and Rehabilitation section of CPT® under the sub-heading "Modalities."

(b) Billing Restrictions:
(i) Provider may bill no more than two separate modality codes and no more than 60 minutes or four units of procedure codes on the same visit. This restriction does not apply to Special Tests referenced in subsection (6) below.

(ii) The maximum allowance for services billed by a Massage

Therapist shall be 72% of the fee schedule.

(iii) The maximum allowance for services billed with a CQ or CO modifier shall be 85% of the fee schedule.

(iv) If a provider performs another service concurrently with a time-based service, the time associated with the concurrent service shall not be included in the time used for reporting the time-based service.

(v) Electrical stimulation is not payable when billed with dry needling and performed on the same body part.

(vi) Providers shall specify all unlisted treatment in the medical record.

CPT® 97139

Non-facility and facility RVUs are 0.87

CPT® 97039

Non-facility and facility RVUs are 0.42

(c) Acupuncture:
(i) All non-physician acupuncture providers must be Licensed

Acupuncturists (L.Ac). Both Physician and L.Acs must provide evidence of training, and licensure upon request of the Payer.

(ii) New or established patient evaluation services are payable if the medical record specifies the appropriate history, physical examination, treatment plan, or evaluation of the treatment plan. Only evaluation services directly performed by a Physician or a L.Ac are payable. All evaluation notes or reports must be written and signed by the Physician or the L.Ac.

L.Ac new patient visit:

DOWC Z0800, $103.84

L.Ac established patient visit:

DOWC Z0801, $70.33

(5) Evaluation Services for Physical Therapists (PTs), Occupational Therapists (OTs) and Athletic Trainers (ATs):
(a) All evaluation services must be supported by the appropriate history, physical examination documentation, treatment goals, and treatment plan or re-evaluation of the treatment plan, as outlined in CPT®. The provider shall clearly state the reason for the evaluation, the nature and results of the physical examination, and the reason for recommending the continuation or adjustment of the treatment protocol. The re-evaluation codes shall not be billed for routine pre-treatment patient assessment.

If a new problem or abnormality is encountered that requires a new evaluation and treatment plan, the provider may perform and bill for another initial evaluation. A new problem or abnormality may be caused by a surgical procedure being performed after the initial evaluation has been completed.

A re-examination, re-evaluation, or re-assessment is different from a progress note. Providers shall not bill these codes for a progress note. Providers may bill a re-evaluation code only if:

(i) professional assessment indicates a significant improvement or decline or change in the injured worker's condition or a functional status that was not anticipated in the plan of care for that time interval;

(ii) new clinical findings become known; or

(iii) the injured worker fails to respond to the treatment outlined in the current plan of care.

(b) A PT or OT may utilize a Rehabilitation Communication Form (WC 196) in addition to a progress note no more than every two weeks for the first six weeks, and once every four weeks thereafter.

The WC 196 form shall not be used for an evaluation, re-evaluation, or reassessment. The form must be completed and specify which validated functional tool was used for assessing the injured worker. The form shall be sent to the referring physician before or at the injured worker's follow-up appointment with the physician.

DoWC Z0817

$15.61.

(c) Only evaluation services directly performed by a PT, OT, or AT are payable. All evaluation notes or reports must be written and signed by the PT, OT, or AT.

(d) An injured worker may be seen by more than one healthcare professional on the same day. Each professional may charge an evaluation service with appropriate documentation per patient, per day.

(e) The RVU for evaluation services performed by ATs shall be equal to the RVU for evaluation services performed by PTs.

(6) Special Tests:
(a) The following are considered special tests:
(i) Job Site Evaluation

(ii) Functional Capacity Evaluation

(iii) Assistive Technology Assessment

(iv) Speech

(v) Physical performance test or measurement

(b) Billing Restrictions:
(i) The following services require prior authorization: Job site evaluations exceeding two hours; Assistive Technology Assessments and Work Tolerance Screenings for more than four hours per test or more than three tests per claim; and Functional Capacity Evaluations for more than four hours per test or two tests per claim.

(ii) The provider shall specify the time required to perform the test in 15-minute increments.

(iii) The analysis and the written report is included in the code's value.

(iv) No E&M services or PT, OT, or acupuncture evaluations shall be charged separately for these tests.

(v) Data from computerized equipment shall always include the supporting analysis developed by the PM&R professional before it is payable as a special test.

(c) All special tests must be fully supervised by a Physician, PT, OT, CCC-SLP, or Audiologist. Final reports must be written and signed by the Physician, PT, OT, CCC-SLP, or Audiologist.

(7) Non-Medical Facility Fees:

Gyms, pools, etc., and training or supervision by non-medical providers require prior authorization and a written negotiated fee for every three month period.

(8) Work Hardening, Conditioning and Simulation:

These programs and recommendations for coverage are defined in the MTGs. All procedures must be performed by or under the onsite supervision of a Physician, Psychologist, PT, OT, CCC-SLP, or Audiologist.

CPT® 97545

Non-facility and facility RVUs are 3.39

CPT® 97546

Non-facility and facility RVUs are 1.7

(9) Wound Care:

Wound care is separately payable only when devitalized tissue is debrided using a recognized method (chemical, water, vacuums).

(I) TELEMEDICINE

(1) In addition to the healthcare services listed in Appendix P of CPT®, and Division Z-codes (when appropriate), services aligning with the following codes may be provided via telemedicine: G0396, G0397, G0406-G0408, G0425-G0427, G0447, G0459, G0508, G0509, 97129, 97130, 97150, 97542, and 97763. Additional services may be provided via telemedicine with prior authorization. The provider shall append modifier 95 to the appropriate code(s) to indicate synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system.

All treatment provided through telemedicine shall comply with the applicable requirements found in the Colorado Medical Practice Act and Colorado Mental Health Practice Act, as well as the rules and policies adopted by the Colorado Medical Board and the Colorado Board of Psychologist Examiners, and shall follow applicable laws, rules, and regulations for informed consent.

(2) HIPAA privacy and electronic security standards are required for the originating site and the rendering provider.

(3) Reimbursement:
(a) The rendering provider may be the only provider involved in the provision of telemedicine services. The rendering provider shall bill place of service (POS) code 02 or 10. Maximum allowance is the appropriate code's non-facility relative weight from RBRVS multiplied by the appropriate CF, unless only a facility weight is established.

(b) An originating site fee may only be billed when the injured worker is receiving services at an authorized originating site. The originating site is responsible for verifying the injured worker and rendering provider's identities. Originating site must bill with the appropriate facility POS code. Authorized originating sites include:

* A Hospital (inpatient or outpatient)

* A Critical Access Hospital (CAH)

* A Rural Health Clinic (RHC)

* A federally qualified health center (FQHC)

* A hospital based renal dialysis center (including satellites)

* A Skilled Nursing Facility (SNF)

* A community mental health center (CMHC)

Maximum allowance for Q3014 is $35.00 per 15 minutes. (Equipment, supplies, and professional fees of supporting providers at the originating site are not separately payable.)

(4) Documentation:

Documentation requirements are the same as for a face-to-face encounter and shall also include the location of both the rendering provider and the injured worker at the time of service, and a statement on how the treatment was rendered through telemedicine (such as secured video).

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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