CO · guidance
CO HCPF Hospice Billing Manual — Institutional Provider Certification
InstitutionalProviderCertification
TheInstitutionalCertificationformisavailableontheProviderFormswebpageundertheClaimFormsandAttachmentsdrop-downmenu.
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HospicebenefitsareprovidedinaccordancewithEarlyandPeriodicScreening,DiagnosticandTreatment(EPSDT)requirementsaslistedin8.280.4.E:"OtherEPSDTBenefits"8.280.4.Ereadsasfollows:
OtherhealthcareservicesmayincludeotherEPSDTbenefitsiftheneedforsuchservicesisidentified.Theservicesareabenefitwhentheymeetthefollowingrequirements:
ProviderscanaskfortheseadditionalservicesbyfollowingthePARprocessasoutlinedforthisbenefit.
AllgoodsandservicesdescribedinSection1905(a)oftheSocialSecurityActareacoveredbenefitunderEPSDTwhenmedicallynecessaryasdefinedat10C.C.R.2505-10,Section8.076.1.8,regardlessofwhethersuchgoodsandservicesarecoveredundertheColoradoMedicaidStatePlan.
ForthepurposesofEPSDT,medicalnecessityincludesagoodorservicethatwill,orisreasonablyexpectedto,assisttheclienttoachieveormaintainmaximumfunctionalcapacityinperformingone(1)ormoreActivitiesofDailyLiving;andmeetsthecriteriasetforthatSection8.076.1.8.b-g.
Theserviceprovidesasafeenvironmentorsituationforthechild.
Theserviceisnotfortheconvenienceofthecaregiver.
Theserviceismedicallynecessary.
Theserviceisnotexperimentalorinvestigationalandisgenerallyacceptedbythemedicalcommunityforthepurposestated.
Theserviceistheleastcostly.
VisittheEPSDTwebpageformoreinformationregardingEPSDT.
ContactGinaRobinsonatGina.Robinson@state.co.uswithquestionsaboutEPSDT.
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EffectiveJuly1,2024,thecollectionofEVVdatawillnolongerberequiredforHospiceservices.
VisittheEVVwebpageorrefertotheEVVProgramManualforfurtherinformationregardingtheEVVprogram.
ContactEVV@state.co.uswithanyEVVquestions.
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Provenance
- Source
- hcpf.colorado.gov
- Retrieved
- 2026-07-26
- Edition
- 2026-07-26
- Content hash
539fbdf907800f8f8ed4bc85f7d340734d69b53711b4f36e636885552aff88f7
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