CO · guidance

CO HCPF Telemedicine and eConsult Billing Manual — Rendering Providers

RenderingProviders

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

Ifarenderingprovider'snumberisrequiredontheclaimforaface-to-facevisit,itisrequiredontheclaimforatelemedicinevisit.

Clinicsandtheotherprovidertypesarerequiredtoentertherenderingprovider'sHealthFirstColoradoprovidernumberinfield19D.

WhenanoriginatingsitebillsQ3014(telemedicineoriginatingsitefacilityfee),thereisgenerallynorenderingprovideractuallyinvolvedintheserviceattheoriginatingsite.

However,arenderingprovidernumberisstillrequiredandmustbeaffiliatedwiththebillingprovider.Thefacilitymayentereitherthemember'susualprovider'snumber,oranotherprovidernumberaffiliatedwiththatsiteastherenderingprovider.

Whenthememberseesarenderingproviderattheoriginatingsiteandalsousesthesiteasthetelemedicineoriginatingsite,thefacilitybillstherenderedserviceprocedurecodeandQ3014fortheuseofthetelemedicinefacility.Thesamerenderingprovidernumberisenteredinfield19D.

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WhenusedbyanFQHCorRHC,themodifierGTidentifiestheservicesasbeingdeliveredthroughtelemedicinemodality.ThereisnoenhancedpaymenttoFQHCsandRHCswhenusingthemodifierGT.

Thefollowingprocedurecodes,whenbilledwithmodifierGTbyappropriateproviders,paythetelemedicinetransmissionfee(anadditional$5.00tothefeelistedinthemostrecentHealthFirstColoradoFeeSchedule).AnyotherprocedurecodesbilledwithmodifierGTwillnotpaythetelemedicinetransmissionfee.WhenprovidingFamilyPlanningviaTelemedicine,appropriateprovidersmayusethecombinationmodifiercodesofFP/GT(inthisorder).

ProcedureCodes

Comments

OutpatientMentalHealth

90791

Ifinteractivecomplexitythenreportwithaddoncode90785

90832

Ifinteractivecomplexitythenreportwithaddoncode90785

90833

UseinconjunctionwithappropriateE/McodeIfinteractivecomplexitythenreportwithaddoncode90785

90834

Ifinteractivecomplexitythenreportwithaddoncode90785

90836

Ifinteractivecomplexitythenreportwithaddoncode90785

90837

Medicarecrossoveronly

90838

Medicarecrossoveronly

90863

canbeaddedtoprimarypsychotherapycode

90846

90847

Evaluation&Management

99201

99202

99203

99204

99205

99211

99212

99213

99214

99215

SpeechTherapy

92507

97532

ObstetricalUltrasounds

76801

76802

76805

76810

76811

76812

76813

76814

76815

76816

76817

Other

96116

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EffectiveJuly1,2025,RemotePatientMonitoring(RPM)isacoveredbenefit.

Remotepatientmonitoring(RPM)isthecontinuoususeoftechnologytotrackapatient’sclinicaldata,enablingearlydetectionofhealthchangesandtimelymedicalinterventionstopreventemergencyinterventionorinpatienthospitalization.RefertotheCodeofColoradoRegulations(10CCR2505-10,Section8.096)formoreinformation.

RemotePatientMonitoringmustberenderedandsupervisedinaccordancewiththescopeofpracticefortheenrolledproviderandperformedbyoneofthefollowinglicensedhealthcareprofessionals:

Physician

Podiatrist

AdvancedPracticeRegisteredNurse

PhysicianAssistant

RespiratoryTherapist

Pharmacist

LicensedhealthcareprofessionalworkingunderthesupervisionofaMedicalDirector

AmemberiseligibleforRemotePatientMonitoring(RPM)ifthemember’shealthcareproviderdeterminesthatRPMismedicallynecessaryandcanpreventmember’sadmissionorreadmissiontoahospital,Emergencydepartment,nursingfacility,orotherclinicalsettingandthememberhasoneofthequalifyingconditionsasindicatedbytheprimarydiagnosisontheclaim:

Diabetes

ChronicObstructivePulmonaryDisease(COPD)

HeartFailure

Asthma

Pneumonia

Memberswhoarepregnantandcarryingahigh-riskpregnancy

FDA-CertifiedorULListed:TechnologicalequipmentrequiredforRPMmustbeFDAcertified,orULlistedandusedaccordingtothemanufacturer’sinstructions.

Maintained:Ingoodrepairandfreefromsafetyhazards

Sanitization:TechnologicalequipmentmustbesanitizedbeforeutilizationintheMember’shomeperthemanufacturer’sinstructions.

HIPPACompliance:Healthcaresoftwareshouldmeetthesecuritystandardsrelatedtopatienthealthinformationbyprotectingpatientdataconfidentiality,integrityandavailability.

AutomaticDataUpload:Equipmentmustbecapableofautomaticallyuploadingdatawithoutthememberneedingtomanuallyself-reportorselfrecordthedata.

RemotePatientMonitoringProcedureCodes:

ProcedureCodes

Detail

Frequency

98016

BrieftelephoneE/M(5-10minutes)byaphysicianorqualifiedprofessionalforanestablishedpatient,notrelatedtoapriorE/Minthepast7daysandnotleadingtoonewithin24hours.

OncePerEpisodeofCare

99091

Collectionandinterpretationofdigitallystored/transmittedphysiologicdata(eg,ECG,bloodpressure,glucosemonitoring)byqualifiedprovider,requiring30+minutes.

OnceaMonth

99445

Collectionandtransmissionofphysiologicdata(e.g.,weight,bloodpressure,pulseoximetry,orrespiratoryflowrate)withdailyrecordingsorprogrammedalertstransmission.

OnceaMonth

99470

Usedforthefirst10minutesofcliniciantimepercalendarmonthmanagingcarebasedonremotelymonitoredphysiologicdata,includingonereal-timeinteractionwiththepatientorcaregiver.

OnceaMonth

99453

Reportsinitialset-upandpatienteducationontheuseofequipment.

OncePerEpisodeofCare

99454

CoversthesupplyoftheRPMdevice,includingdailyrecordingandprogrammedalerttransmission.Usedforeachadditional20minutesofcliniciantimepermonth.

OnceaMonth

99457

Usedfor20minutesofcliniciantimepermonthmanagingcarebasedonRPMdata,withliveinteractionwiththepatientorcaregiver.

OnceaMonth

99458

Usedforanadditional20minutesofcliniciantimemanagingcarewithRPMdata.

OnceaMonth

*EpisodeofCare:Beginningwhentheremotephysiologicmonitoringserviceisinitiatedandendswithattainmentoftargetedtreatmentgoals.

Foradditionalinformation,refertotheRemotePatientMonitoringforOutpatientClinicalServicesFAQ.

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Provenance

Source: hcpf.colorado.gov
Retrieved: 2026-07-26
Edition: 2026-07-26
Content hash: 888f393111f00ed88da2a4922def87e1780d2ad5aba4d4225951b4f76db5ed32

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