CO · guidance

CO HCPF Emergency Medicaid Services Billing Manual — Billing Guidance

BillingGuidance

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

PertheDepartmentofHealthCarePolicy&Financing(theDepartment)regulationsat10CCR2505-10,§8.100.3.G.1.g.viii,aprovidermustcertifythepresenceofanemergencymedicalconditionwhenservicesareprovided.ClaimssubmittedforEMSmembersmusthavetheappropriateemergencyindicatoronclaimforms.Theprovidermustusethefollowingclaimformfieldstocertifythattheclaimedservicesrelatetoemergencymedicalconditions:

ClaimForm

Requiredfieldcompletiontocertifythepresenceofanemergency

CMS1500

Field24C:Enter"X"foreachbilledline

UB-04

TypeofAdmission01(Emergency)or05(Trauma)

BillingforServicesCoveredbytheEMSBenefitPlan

ServiceType

Definition

BillingGuidance

CareSetting

Examples(Include,butnotlimitedto)

EmergencyServices

Servicesnecessarytotreatanemergencycondition

EmergencyIndicatororAdmissionType(1or5)

Settingtotreatanemergencycondition(doesnotneedtobeanemergencyroom)

Healthemergencies(e.g.,chestpain,heartattack,appendicitis,diabeticemergencies

Laboranddelivery

DialysisforEnd-StageRenalDisease(ESRD)

TraumaticInjuries(e.g.,brokenbones,largecuts)

FamilyPlanningServices

Servicestodelay,planorpreventapregnancy

Modifier(FP)orcoveredInternationalClassificationofDiseases(ICD)codes

Familyplanningsetting(notanemergency)

AnyFoodandDrugAdministration(FDA)-approvedcontraceptive

Sterilization

Contraceptivecounseling

FamilyPlanning-RelatedServices

Servicesprovidedpursuanttoafamilyplanningvisit

Modifiers(FP+32)orcoveredICDcodes

Familyplanningsetting(notanemergency)

SexuallyTransmittedInfection(STI)screeningandtreatment

Cervicalcancerscreeningandprevention

Preventativeservices

ConcernsregardingdeniedclaimsshouldbedirectedtotheDepartment’sfiscalagent,GainwellTechnologies.RefertotheProviderContactwebpageforinformation.

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Provenance

Source: hcpf.colorado.gov
Retrieved: 2026-07-26
Edition: 2026-07-26
Content hash: af859fb702a0e964b3979d6f05a96d78aa5b06ca027ac2826a76ac1b65052a20

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