CO · guidance
CO HCPF Telemedicine and eConsult Billing Manual — eConsults Overview
eConsultsOverview
EffectiveFebruary1,2024,eConsultsthatmeetthecriteriabelowareacoveredbenefit.
EffectiveAugust31,2026,theeConsultplatformcurrentlysupportedbytheDepartmentwillnolongerbeavailable.
eConsult:AnasynchronousdialogueinitiatedbyaTreatingPractitionerseekingaConsultingPractitioner’sexpertopinionwithoutaface-to-facememberencounterwiththeConsultingPractitioner.
TreatingPractitioner:Amember’streatingphysicianorotherqualifiedhealthcarepractitionerwhoisaprimarycareprovidercontractedwithaRegionalAccountableEntitytoparticipateintheAccountableCareCollaborativeasaNetworkProvider.
EffectiveJuly1,2025,ATreatingPractitionermayalsobeamember’streatingproviderwhohaseducation,training,orqualificationinaspecialtyfieldotherthanprimarycareandisamedicaldoctor(MD),doctorofosteopathy(DO),NursePractitioners(NPs),andPhysicianAssistants(PAs).
ConsultingPractitioner:Aproviderwhohaseducation,trainingorqualificationsinaspecialtyfieldotherthanprimarycare.
eConsultPlatform:Providerscanutilizethird-partyeConsultplatformsthatmeettheDepartment’scriteria.
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PlatformmustbecapableofmaintainingdocumentationthattheeConsultisdirectlyrelevanttotheindividualpatient’sdiagnosisandtreatment,andtheconsultingpractitionerhasspecializedexpertiseintheparticularhealthconcernsofthepatient.
PlatformmustbecapableofidentifyingtheColoradoMedicaidenrollmentstatusofprovidersusingtheplatform.AllprovidersmustbelicensedinthestateofColorado.
Platformmeetsallstateandfederalprivacylawsregardingtheexchangeofpatientinformation.
Platformmustbecapableofprovidingsufficientdocumentationforthetreatingandconsultingprovidertodemonstratethattheconsultationwasprovidedforthedirectbenefitofthemember.
Platformmustprovidethetreatingandconsultingpractitionerwiththeinformationnecessarytofileaclaimincludingdateofservice;nameofrecipient;Medicaididentificationnumber;nameofprovideragencyorpersonprovidingtheservice;nature,extentorunitsofserviceandtheplaceofservice.
TreatingPractitionersBilling:
UseCPTcode99452
Thedateofservicefor99452shouldbethedatetheeConsultwascompleted.
Treatingpractitionersuse99452toreportaneConsultoutsideofanevaluationandmanagementservice.AneConsultcompletedonthesamedateofserviceasanofficevisitisconsideredpartoftheevaluationandmanagementserviceandwillnotbereimbursedseparatelyperNCCI.
Servicesmustmeettheproceduraldefinitionandcomponents,includingtimerequirements,oftheCPTcodeasdefinedbytheAMAinadditiontorequirementslistedhere.
TreatingPractitionerReimbursement:
PleaseseetheHealthFirstColoradofeeschedule
ConsultingPractitionersBilling:
UseCPTCode99451
Servicesmustmeettheproceduraldefinitionandcomponentsincludingtimerequirements,oftheCPTcodeasdefinedbytheAMAinadditiontorequirementslistedhere.
ConsultingPractitionerReimbursement:
PleaseseetheHealthFirstColoradofeeschedule
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eConsultdialoguesbetweenTreatingPractitionersandConsultingPractitionersdonotmeetthedefinitionofanFQHCorRHCvisitasdefinedinCCR8.700.CostsassociatedwithperformingeConsultsthroughanFQHC/RHCareconsideredallowablecostsforthecostreportandwillbeincludedinthecalculationofthereimbursementrateforapatientvisitatanFQHC/RHC.
RefertotheCodeofColoradoRegulations(1-CCR2505-10,Section8.095)formoreinformation.
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Provenance
- Source
- hcpf.colorado.gov
- Retrieved
- 2026-07-26
- Edition
- 2026-07-26
- Content hash
b1ad787296863ac6192c364a761fe8ed621d0ed267d6713c07c21e8621fc8a60
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