CO · guidance
CO HCPF Outpatient Imaging and Radiology Billing Manual — Benefit Limitations
BenefitLimitations
Proceduresforcosmetictreatmentorinfertilitytreatment(ICD-10N97)arenotcovered.
ProceduresconsideredexperimentalornotapprovedbytheFoodandDrugAdministration(FDA)arenotcovered.
Proceduresnotorderedbythemember'sattendingortreatingphysicianarenotcovered.
Procedureswhicharepartofaclinicalstudyarenotcovered.
BacktoTop
CTofsinusesforacute,uncomplicatedrhinosinusitis(ICD-10J01)isnotcovered.
VirtualColonoscopy(CPTs74261,74262,75263)iscoveredatafrequencyofonceeveryfive(5)years.
BacktoTop
Imagingofcorticalboneandcalcifications,andproceduresinvolvingspatialresolutionofboneandcalcificationsarenotcovered.
Imagingofthesameanatomicareatoaddresspatientpositionalchanges,additionalsequences,orequipmentfailureisnotallowed.Thesevariationsorextrasequencesareincludedwithintheoriginalimagingauthorizationrequest.
BacktoTop
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).
BacktoTop
Provenance
- Source
- hcpf.colorado.gov
- Retrieved
- 2026-07-26
- Edition
- 2026-07-26
- Content hash
18d484e65bff398ac27287001eab07e1b0a5ae468f341661e3bd4911c8f8a9b8
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.