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CO · guidance

CO HCPF Outpatient Imaging and Radiology Billing Manual — Benefit Limitations

BenefitLimitations

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

Proceduresforcosmetictreatmentorinfertilitytreatment(ICD-10N97)arenotcovered.

ProceduresconsideredexperimentalornotapprovedbytheFoodandDrugAdministration(FDA)arenotcovered.

Proceduresnotorderedbythemember'sattendingortreatingphysicianarenotcovered.

Procedureswhicharepartofaclinicalstudyarenotcovered.

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CTofsinusesforacute,uncomplicatedrhinosinusitis(ICD-10J01)isnotcovered.

VirtualColonoscopy(CPTs74261,74262,75263)iscoveredatafrequencyofonceeveryfive(5)years.

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Imagingofcorticalboneandcalcifications,andproceduresinvolvingspatialresolutionofboneandcalcificationsarenotcovered.

Imagingofthesameanatomicareatoaddresspatientpositionalchanges,additionalsequences,orequipmentfailureisnotallowed.Thesevariationsorextrasequencesareincludedwithintheoriginalimagingauthorizationrequest.

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HealthFirstColoradocoversannualscreeningforlungcancerinaccordancewiththeU.S.PreventiveServicesTaskForce(USPSTF)recommendation.

ThefollowingpoliciesareeffectiveasofJanuary1,2021:

HCPCScodeG0297hasbeenreplacedwithCPTcode71271.

CPTcode71271mustbeusedandalwaysrequiresPriorAuthorization.

ICD-10diagnosiscodeZ12.2mustbereportedontheclaim.

Benefitislimitedtoone(1)screening(one[1]billedunitofservice)perstatefiscalyear(July1-June30).

ThefollowingpolicieswereeffectivepriortoJanuary1,2021:

HCPCScodeG0297mustbeused.G0297alwaysrequiresPriorAuthorization.

ICD-10diagnosiscodeZ12.2mustbereportedontheclaim.

Benefitislimitedtoone(1)screening(one[1]billedunitofservice)perstatefiscalyear(July1-June30).

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Provenance

Source
hcpf.colorado.gov
Retrieved
2026-07-26
Edition
2026-07-26
Content hash
18d484e65bff398ac27287001eab07e1b0a5ae468f341661e3bd4911c8f8a9b8
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