CO · guidance

CO HCPF Dialysis Billing Manual — Reimbursement

Reimbursement

activein force · 2026-07-26 – presentas-observed

Theamountofpaymentforoutpatientdialysisornecessarysuppliesforhomedialysistreatments,whenprovidedbyaseparatedialysiscenterwithinahospitaloranindependent,free-standingdialysistreatmentcenterapprovedforparticipationbytheDepartment,shallbethelesserofthedialysiscenter'schargesorthecurrentlypostedHealthFirstColoradorate.

ThefollowingdialysisservicesarereimbursedatthelowerofthecompositeMedicarerateceilingortheindividualcenter'sMedicarefacilityrate:

Outpatienthemodialysis

Outpatientperitonealdialysis

ContinuousAmbulatoryPeritonealDialysis(CAPD)

ContinuousCyclingPeritonealDialysis(CCPD)

Thereisnoreimbursementforhomedialysis,exceptfornecessaryhomedialysisequipmentandsupplies.

BacktoTop

RoutineservicesperformedwiththedialysistreatmentshallbeconsideredpartofthecompositerateandbilledontheUB-04claimformorelectronicallyonthe837Itransaction.

Reportroutineserviceswithappropriaterevenuecodes.RefertoAppendixQontheBillingManualswebpageundertheAppendicesdrop-downforvaliddialysisrevenuecodes.

Chargesbyadialysisfacilityforroutinedrugsandlaboratoryservices,electrocardiograms(EKGs)andX-raysareconsideredpartofthedialysistreatment.

BacktoTop

Non-routineservicesperformedinadditiontothedialysistreatmentshallbereimbursedseparatelyandbilledontheCMS1500professionalclaimformorelectronicallyasan837Ptransaction.ThisrequiresthattheproviderusetheappropriateHealthcareCommonProcedureCodingSystem(HCPCS)codesdesignatedfortheserviceprovided.Onlynon-routineservicesperformedinadditiontothedialysistreatmentmaybeincludedontheprofessionalclaim.

Theamountofpaymentfornon-routineoutpatientdialysistreatments,whenprovidedbyaseparatedialysiscenterwithinahospitaloranindependent,free-standingdialysistreatmentcenter,shallbebasedupontheHealthFirstColoradofeeschedule.

Non-routinedrugsmustbebilledontheCMS1500professionalpaperclaimformorasan837Professional(837P)electronictransactionusingthedialysiscenterNPInumber.

Drugsnotdispensedbythedialysisproviderarebilledbyandreimbursedtothedispensingpharmacy.

Physician'schargesforEKGorX-rayservicesmustbebilledbythephysician.

AphysicianmustsupervisetheprocesswhenbloodisfurnishedandmaybillforanyprofessionallyrenderedcoveredserviceusingtheirNPInumber.

BacktoTop

Routinelaboratoryservicesareincludedaspartofthedialysisservicereimbursement.

Non-routinelaboratoryservicesarereimbursedaslaboratoryservicesseparatefromthedialysistreatment.HospitalshavingseparatedialysisunitsmustsubmitservicesaccordingtooutpatienthospitallaboratoryregulationsandUB-04institutionalbillinginstructions.

AfreestandingdialysiscenterthatperformsitsownlaboratorytestsmustbelicensedasanindependentclinicallaboratoryandenrolledinHealthFirstColoradoasanindependentlaboratory.Thenon-routinelaboratoryservicesmustbebilledundertheindependentlaboratory'sNPInumberontheCMS1500professionalclaimformorelectronicallyasan837Ptransaction.

Ifanoutsidelaboratoryprovidestheservice,thatlaboratorymustbillfortheservice.Allroutinelaboratoryservicesperformedbyadialysistreatmentfacility,withthedesignationasacertifiedclinicallaboratory,orasacertifiedindependentlaboratoryareincludedaspartofthedialysistreatmentreimbursement.Allroutinetestsmustbeperformedbythefacility,withdesignationasacertifiedclinicallaboratory,andreimbursedaspartofthecompositerateorperformedbyacertifiedindependentoutsidelaboratoryandbilledtothefacilityperformingthedialysistreatment.

Thefollowingproceduresanddrugsconstituteroutineservices.Theseservicesareincludedaspartofthedialysiscenter’scompositerate.

RoutineLabs/Procedures

AlkalinePhosphatase

AllHematocritandClottingtimetests

AspartateAminotransferase(AST)orSerumGlutamic-OxaloaceticTransaminase

AssayofParathormone

Automatedbatteryoftests(SMA-12)

BicarbonateDialysate

BloodUreaNitrogen(BUN)

CompleteBloodCount(CBC)

CarbonDioxide(CO2)

DialysateProtein

Electrolytepanel

Hematocrit

Hemoglobin

Hepaticfunctionpanel

Iron

LactateDehydrogenase(LDH)

Magnesium

Metabolicpanel

PlateletCount

RedBloodCount

Renalfunctionpanel

Reticulocyte

SalineFlush

SerumAlbumin

SerumAluminum

SerumBicarbonate

SerumCalcium

SerumChloride

SerumCreatinine

SerumFerritin

SerumPhosphorous

SerumPotassium

SerumSodium

SpecimenCollection

TotalProtein

Transferrin

VitaminD

WhiteBloodCount

RoutineDrugs

Calcitriol

Darbepoetinalfa,Epoetinalfa,EpoetinbetaorEpogen

Doxercalciferol

Hematinics

Heparin

Irondextran,Ironsucrose,Sodiumferricgluconatecomplexinsucroseinjection,orFerumoxytol

Oxygen

Paricalcitol

Parsabiv(etelcalcetide)

NonparenteralitemsmaynotbebilledseparatelybythedialysiscenterbutmaybebilleddirectlytoHealthFirstColoradobythesupplier.Nonparenteralitemsadministeredduringthedialysistreatmentarereimbursedaspartofthecompositerate.

BacktoTop

Provenance

Source: hcpf.colorado.gov
Retrieved: 2026-07-26
Edition: 2026-07-26
Content hash: 1de441a118b498f178d50426465c64b1b090604bb893acf0267cef7b13d42b63

View the official source →

The link goes to the issuing authority’s own document — the one we read to produce this record. Where a source publishes whole titles rather than sections, your browser may need a moment to jump to the provision.

Unofficial copy of government-published law, reproduced from official sources with full provenance. Not an official publication; verify against official sources before relying on it in a filing. Records in the 'guidance' corpus, and only that corpus, are sub-regulatory (interpretive guidelines, survey procedures) and are not binding law. Validity bounds follow each jurisdiction's declared temporalBasis.

Coverage · API docs