CO · guidance
CO HCPF Pediatric Behavioral Therapies Billing Manual — Payment for Covered Services
PaymentforCoveredServices
(1)(a)(I)Exceptasprovidedinsection25.5-4-302andsubparagraph(III)ofthisparagraph(a),norecipientorestateoftherecipientshallbeliableforthecostorthecostremainingafterpaymentbyMedicaid,Medicare,oraprivateinsurerofmedicalbenefitsauthorizedbyTitleXIXofthesocialsecurityact,bythistitle,orbyrulespromulgatedbythestateboard,whichbenefitsarerenderedtotherecipientbyaproviderofmedicalservicesauthorizedtorendersuchserviceinthestateofColorado,exceptthosecontributionsrequiredpursuanttosection25.5-4-209(1).However,arecipientmayenterintoadocumentedagreementwithaproviderunderwhichtherecipientagreestopayforitemsorservicesthatarenon-reimbursableunderthemedicalassistanceprogram.Underthesecircumstances,arecipientisliableforthecostofsuchservicesanditems.
Technical/lackofinformation(LOI)denialdoesnotmeanthoseservicesarenotcovered.MembersmaynotbebilledforservicesdeniedforLOI.
Servicespartiallyapprovedarestillconsideredcoveredservices.Membersmaynotbebilledforthedeniedportionoftherequest.
Servicestotallydeniedfornotmeetingmedicalnecessitycriteriaareconsiderednon-coveredservices.
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Provenance
- Source
- hcpf.colorado.gov
- Retrieved
- 2026-07-26
- Edition
- 2026-07-26
- Content hash
a8151e7f00b8bd1a21f2c85b40b27afd94e067eaafa06179d15491d13cefa08e
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