CO · guidance
CO HCPF Gender-Affirming Care Billing Manual — Member Eligibility
MemberEligibility
Memberswithaclinicaldiagnosisofgenderdysphoriaareeligibleforthegender-affirmingcareservicesbenefit,subjecttotheservice-specificcriteriaandrestrictionsdetailedin10CCR2505-108.735.4.Thefollowingrequirementsapplytoallcoveredgender-affirmingcare:
Memberhasaclinicaldiagnosisofgenderdysphoria.
Requestedserviceismedicallynecessary,asdefinedinsection8.076.1.8.
Anyco-existingphysicalandbehavioralhealthconditionsdonotinterferewithdiagnosticclarityorcapacitytoconsent,andassociatedrisksandbenefitshavebeendiscussed.
Memberhasgiveninformedconsentfortheservice.
SubjecttotheexceptionsinC.R.S.§13-22-103,ifmemberisunder18yearsofage,member'sparent(s)orlegalguardianhasgiveninformedconsentfortheservice.
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Requestsforservicesformembersunder21yearsofageareevaluatedinaccordancewiththeEarlyandPeriodicScreening,DiagnosisandTreatment(EPSDT)programcriteriadetailedinsection8.280.
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Provenance
- Source
- hcpf.colorado.gov
- Retrieved
- 2026-07-26
- Edition
- 2026-07-26
- Content hash
ae4f367d003dbda4c8c5e62b09856b0c6d8e2acfffafb4d89bcef455a0f0bf24
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