CO · guidance
CO HCPF Private Duty Nursing Billing Manual — Early and Periodic Screening, Diagnostic and Treatment
EarlyandPeriodicScreening,DiagnosticandTreatment
PrivateDutyNursingbenefitsareprovidedinaccordancewithEarlyandPeriodicScreening,DiagnosticandTreatment(EPSDT)requirementsaslistedin8.280.4.E:“OtherEPSDTBenefits”8.280.4.Ereadsasfollows:
OtherhealthcareservicesmayincludeotherEPSDTbenefitsiftheneedforsuchservicesisidentified.Theservicesareabenefitwhentheymeetthefollowingrequirements:
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.
ProviderscanaskfortheseadditionalservicesbyfollowingthePARprocessasoutlinedforthisbenefit.
VisittheEPSDTwebpageformoreinformationregardingEPSDT.
ContactGinaRobinsonatGina.Robinson@state.co.uswithquestionsaboutEPSDT.
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Provenance
- Source
- hcpf.colorado.gov
- Retrieved
- 2026-07-26
- Edition
- 2026-07-26
- Content hash
2df5b06ea828ecbd8450a081883594bd8e7b06aafdfec5cb5a4e3679e434aedf
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