Colorado

STATUS: Still available on COVID-19 Provider Information Website (under Telemedicine Billing Guidance), however many COVID-19 policies have expired or been made permanent. See Telemedicine Billing Manual for Post-Public Health Emergency Policy and End of the Public Health Emergency Page for more information.

Medicaid: Home and Community Based Services (HCBS) waiver benefits

STATUS: See Policy Memo – Unwinding Appendix K Flexibilities and End of the Public Health Emergency Page for more information regarding permanent and expiring HCBS telehealth policies.

Medicaid: HCBS Telehealth Billing Guidance

STATUS: See Policy Memo – Unwinding Appendix K Flexibilities and End of the Public Health Emergency Page for more information regarding permanent and expiring HCBS telehealth policies.

Medicaid: Changes to HCBS Waivers Postponed – Telehealth still allowable consistent with above memos

STATUS: See Policy Memo – Unwinding Appendix K Flexibilities and End of the Public Health Emergency Page for more information regarding permanent and expiring HCBS telehealth policies.

Medicaid: Bulletin includes Physician Services, FQHCs/RHCs, IHSs, Telemedicine Guidance for PHE and Beyond

STATUS: Active.

Last updated 08/04/2023

Cross State Licensing

Department of Public Health: COVID-19 Telehealth Regulation Changes

STATUS: Active.

Department of Regulatory Agencies: FAQs on COVID-19 Telehealth Services

STATUS: Active and still available on Dept. of Regulatory Agencies COVID-19 Website (under Insurance), however other documents available on the website state that they have not been updated in light of the expiration of most statewide mandates.

Division of Professions and Occupations: Emergency Licensure Regulations

STATUS: Active, however, website states emergency rules related to COVID-19 expired May 4, 2023.

Division of Professions and Occupations: Information on Telehealth Services

STATUS: Varies, has not been updated in light of the expiration of most statewide mandates.

Last updated 08/04/2023

Easing Prescribing Requirements

Medicaid: End of the Public Health Emergency Page

Department of Health: COVID-19 Telehealth Regulation Changes

STATUS: Active.

Division of Professions and Occupations: Emergency Regulations

STATUS: Active, however, website states emergency rules related to COVID-19 expired May 4, 2023.

Department of Regulatory Agencies: FAQs on COVID-19 Telehealth Services

Last updated 08/04/2023

Miscellaneous

Department of Public Health: Public Health Orders and Executive Orders

STATUS: COVID-19 Orders expired May 11, 2023.

Department of Regulatory Agencies: FAQs on COVID-19 Telehealth Services

Medicaid: End of the Public Health Emergency Page

Last updated 08/04/2023

Originating Site

Medicaid: Provider Bulletin – Changes to Telemedicine Post-Public Health Emergency (PHE)

STATUS: Active. Bulletin lists emergency telehealth policies that have been made permanent and those that have expired.

Medicaid: End of the Public Health Emergency Page

Medicaid: Telemedicine Provider Information

STATUS: Active. Website refers providers to the Telemedicine Billing Manual for Post-Public Health Emergency Policy.

Department of Health: COVID-19 Telehealth Regulation Changes

STATUS: Active.

Last updated 08/04/2023

Private Payer

Division of Insurance: Policy Directive

STATUS: Active.

Department of Public Health: COVID-19 Telehealth Regulation Changes

STATUS: Active.

Department of Regulatory Agencies: FAQs on COVID-19 Telehealth Services

Last updated 08/04/2023

Provider Type

Medicaid: Provider Bulletin – Changes to Telemedicine Post-Public Health Emergency (PHE)

STATUS: Active. Bulletin lists emergency telehealth policies that have been made permanent and those that have expired.

Medicaid: End of the Public Health Emergency Page

Medicaid: Telemedicine Provider Information

STATUS: Active. Website refers providers to the Telemedicine Billing Manual for Post-Public Health Emergency Policy.

Department of Health: COVID-19 Telehealth Regulation Changes

STATUS: Active.

Medicaid: Provider Bulletin – Physician Services, FQHCs/RHCs, IHSs, Telemedicine Guidance for PHE and Beyond

STATUS: Active.

Medicaid: Provider Bulletin – Physician Services, Federally Qualified Health Center (FQHC), Rural Health Center (RHC) Providers – Well Child Check-ups Via Telemedicine Update

STATUS: Coverage of Well Child Check-Up Codes expired effective May 12, 2023.

Last updated 08/04/2023

Service Expansion

Medicaid: Provider Bulletin – Changes to Telemedicine Post-Public Health Emergency (PHE)

STATUS: Active. Bulletin lists emergency telehealth policies that have been made permanent and those that have expired.

Medicaid: End of the Public Health Emergency Page

Medicaid: Telemedicine Provider Information

STATUS: Active. Website refers providers to the Telemedicine Billing Manual for Post-Public Health Emergency Policy.

Department of Health: COVID-19 Telehealth Regulation Changes

STATUS: Active.

Medicaid: Provider Bulletin – Physician Services, FQHCs/RHCs, IHSs, Telemedicine Guidance for PHE and Beyond

STATUS: Active.

Medicaid: Provider Bulletin – Physician Services, Federally Qualified Health Center (FQHC), Rural Health Center (RHC) Providers – Well Child Check-ups Via Telemedicine Update

STATUS: Coverage of Well Child Check-Up Codes expired effective May 12, 2023.

Medicaid: Policy Memo – Unwinding Appendix K Flexibilities

STATUS: Effective May 11, 2023.

Medicaid: Behavioral Health Services Fact Sheet

Medicaid: Regional Accountable Entity Behavioral Health Telemedicine Services

Medicaid: Teledentistry Services

Medicaid: Home and Community Based Services (HCBS) waiver benefits

STATUS: See Policy Memo – Unwinding Appendix K Flexibilities and End of the Public Health Emergency Page for more information regarding permanent and expiring HCBS telehealth policies.

Medicaid: HCBS Telehealth Billing Guidance

STATUS: See Policy Memo – Unwinding Appendix K Flexibilities and End of the Public Health Emergency Page for more information regarding permanent and expiring HCBS telehealth policies.

Medicaid: Changes to HCBS Waivers Postponed – Telehealth still allowable consistent with above memos

STATUS: See Policy Memo – Unwinding Appendix K Flexibilities and End of the Public Health Emergency Page for more information regarding permanent and expiring HCBS telehealth policies.

Medicaid: Bulletin on Telemedicine Services (# B2000450)

STATUS: Still available on Provider Bulletins Website, however many COVID-19 policies have expired or been made permanent. See Telemedicine Billing Manual for Post-Public Health Emergency Policy and End of the Public Health Emergency Page for more information.

Private Payer

Last updated 08/08/2023

Definitions

Telehealth means a mode of delivery of healthcare services through HIPAA compliant telecommunications systems, including information, electronic, and communication technologies, remote monitoring technologies, and store-and-forward transfers, to facilitate the assessment, diagnosis, consultation, treatment, education, care management, or self-management of a covered person’s health care while the covered person is located at an originating site and the provider is located at a distant site.

SOURCE: CO Revised Statutes 10-16-123(4)(e). (Accessed Aug. 2023).

Workers’ Compensation

Telemedicine means two-way, real time interactive communication between the injured worker and the provider at a distant site. This electronic communication involves, at a minimum, audio and video telecommunications equipment. Telemedicine enables the remote evaluation and diagnosis of injured workers in addition to the ability to detect fluctuations in their medical condition(s) at a remote site in such a way as to confirm or alter the treatment plan, including medications and/or specialized therapy.

SOURCE: CO Permanent Rules, Sec. 7 CCR 1101-3, (Accessed Aug. 2023).

Last updated 08/08/2023

Parity

SERVICE PARITY

CO insurers cannot deny coverage solely because the service is provided through telehealth rather than in-person consultation or contact between the participating provider or, subject to section 10-16-704, the nonparticipating provider and the covered person where the health care service is appropriately provided through telehealth; or based on the communication technology or application used to deliver the telehealth services pursuant to this section. However, use of the word solely, may mean they can find other reasons, such as the service doesn’t meet the appropriate standard of care in the insurer’s view.

SOURCE: CO Revised Statutes 10-16-123(2)(b)(II). (Accessed Aug. 2023).

PAYMENT PARITY

Subject to all terms and conditions of the health benefit plan or dental plan, a carrier shall reimburse the treating participating provider or the consulting participating provider for the diagnosis, consultation, or treatment of the covered person delivered through telehealth on the same basis that the carrier is responsible for reimbursing that provider for the provision of the same service through in-person consultation or contact by that provider.

SOURCE: CO Revised Statutes 10-16-123(2)(b)(I). (Accessed Aug. 2023).

According to Revised Bulletin No. B-4.89, the CO Division of Insurance interprets the above law to require reimbursement for telehealth services at no less than for in-person services, and states that carriers must continue to reimburse providers in parity with in-person rates post-COVID-19 public health emergency. In addition, the Bulletin states that payment parity applies to all medically necessary covered health care services that are appropriately provided through telehealth, including but not limited to behavioral health, mental health, substance use disorder, occupational therapy, speech therapy, physical therapy services, dental services, and remote monitoring of patients.

SOURCE: CO Division of Insurance Policy Directives for Telehealth. Aug. 18. 2021. (Accessed Aug. 2023).

Last updated 08/08/2023

Requirements

A health benefit plan or dental plan that is issued, amended or renewed shall not require in-person contact between a provider and a covered person for services appropriately provided through telehealth, subject to all terms and conditions of the health plan or dental plan.

A carrier shall not restrict or deny coverage solely because the service is provided through telehealth or based on the communication technology or application used to deliver the telehealth services.

A health plan or dental plan is not required to pay for consultation provided by a provider by telephone or facsimile unless the consultation is provided through HIPAA compliant interactive audio-visual communication or the use of a HIPAA compliant application via a cellular telephone.

A carrier shall include in the payment for telehealth interactions reasonable compensation to the originating site for the transmission cost incurred during the delivery of health care services through telehealth except for when the originating site is a private residence.

SOURCE: CO Revised Statutes 10-16-123. (Accessed Aug. 2023).

A carrier shall not:

1. 1. Impose an annual dollar maximum on coverage for health care services covered under the health benefit plan or dental plan that are delivered through telehealth, other than an annual dollar maximum that applies to the same services when performed by the same provider through in-person care;
  2. Impose specific requirements or limitations on the HIPAA-Compliant technologies that a provider uses to deliver telehealth services, including limitations on audio or live video technologies;
  3. Require a covered person to have a previously established patient-provider relationship with a specific provider in order for the covered person to receive medically necessary telehealth services from the provider; or
  4. Impose additional certification, location, or training requirements on a provider as a condition of reimbursing the provider for providing health care services through telehealth.

SOURCE: CO Statute 10-16-123. (Accessed Aug. 2023).

Workers’ Compensation

In addition to the healthcare services listed in Appendix P of CPT, and Division Z- codes (when appropriate), the following CPT codes may be provided via telemedicine: G0396, G0397, G0406-G0408, G0425-G0427, G0447, G0459, G0508, G0509, 97129, 97130, 97150, 97542, and 97763. Additional services may be provided via telemedicine with prior authorization. The provider shall append modifier 95 to the appropriate CPTÂ® code(s) to indicate synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system.

All treatment provided through telemedicine shall comply with the applicable requirements found in the Colorado Medical Practice Act and Colorado Mental Health Practice Act, as well as the rules and policies adopted by the Colorado Medical Board and the Colorado Board of Psychologist Examiners and shall follow applicable laws, rules and regulations for informed consent.

HIPAA privacy and electronic security standards are required for the originating site and the rendering provider.

The physician-patient/psychologist-patient relationship needs to be established.

This relationship is established through assessment, diagnosis, and treatment of the injured worker. Both in-person evaluation and, two-way live audio/video services are among acceptable methods to ‘establish’ a patient relationship.

The rendering provider may be the only provider involved in the provision of telemedicine services. The rendering provider shall bill place of service (POS) code 02. Maximum allowance is the appropriate CPTÂ® code’s non- facility relative weight from RBRVS multiplied by the appropriate CF, unless only a facility weight is established.

An originating site fee may only be billed when the injured worker is receiving services at an authorized originating site. The originating site is responsible for verifying the injured worker and rendering provider’s identities. Originating site must bill with the appropriate facility POS code. Authorized originating sites include:

A Hospital (inpatient or outpatient)
A Critical Access Hospital (CAH)
A Rural Health Clinic (RHC)
A federally qualified health center (FQHC)
A hospital based renal dialysis center (including satellites)
A Skilled Nursing Facility (SNF)
A community mental health center (CMHC)

Maximum allowance for Q3014 is $35.00 per 15 minutes. (Equipment, supplies, and professional fees of supporting providers at the originating site are not separately payable.)

Documentation requirements are the same as for a face-to-face encounter and shall also include the location of both the rendering provider and the injured worker at the time of service, and a statement on how the treatment was rendered through telemedicine (such as secured video).

SOURCE: CO Permanent Rules, Sec. 7 CCR 1101-3, (Accessed Aug. 2023).

Medicaid

Last updated 08/08/2023

Consent Requirements

Providers shall give all first-time patients a written statement that includes the following:

The patient may refuse telemedicine services at any time without affecting the patient’s right to future care or treatment and without risking the loss or withdrawal of any program benefits to which the patient would otherwise be entitled;
All applicable confidentiality protections shall apply to the services;
The patient shall have access to all medical information resulting from the services, under state law.

SOURCE: CO Revised Statutes 25.5-5-320. (Accessed Aug. 2023).

Providers must document the member’s consent, either verbal or written, to receive telemedicine services.

The Medicaid requirement for face-to-face contact between provider and member may be waived when treating the member through telemedicine. In-person contact between a health care provider and a member is not required for services delivered through telemedicine that are otherwise eligible for reimbursement. Prior to treating the member through telemedicine for the first time, the provider must furnish each member with all of the following written statements, which must be signed (electronic signatures will be accepted) by the member or the member’s legal representative:

The member retains the option to refuse the delivery of health care services via telemedicine at any time without affecting the member’s right to future care or treatment and without risking the loss or withdrawal of any program benefits to which the member would otherwise be entitled.
All applicable confidentiality protections shall apply to the services.
The member shall have access to all medical information resulting from the telemedicine services as provided by applicable law for client access to his or her medical records.

These requirements do not apply in an emergency.

SOURCE: CO Department of Health Care Policy and Financing. “Telemedicine Billing Manual” 7/23. (Accessed Aug. 2023).

Covered telemedicine services must be provided only after the member’s consent, either verbal or written, to receive telemedicine services is documented.

SOURCE: CO Adopted Rule 8.095.4.A. (Accessed Aug. 2023).

All consent for telemedicine services could be verbal during the PHE. Providers must obtain written consent prior to the first visit post-PHE, as described in the Waiving the Face-to-Face Requirement & Required Disclosure Statements section of the Telemedicine Billing Manual.

SOURCE: CO Dept. of Health Care Policy and Financing, Provider Bulletin, June 2023. (Accessed Aug. 2023).

Home and Community Based Services (HCBS)

HCBS waiver providers shall ensure the use of HCBS Telehealth is the choice of the Member. The HCBS waiver provider shall maintain a consent form for the use of HCBS Telehealth in the Member’s record.

SOURCE: CO Adopted Rule 8.615.4. (Accessed Aug. 2023).

When Remote Supports includes the use of live audio and/or video equipment that permits a Remote Supports Provider to view activities and/or listen to conversations in the residence, the Client who receives the service and each person who lives with the Client shall consent in writing after being fully informed of what Remote Support entails.

SOURCE: CO Adopted Rule 8.488.40. (Accessed Aug. 2023).

Early Childhood Intervention Program

Service coordinators shall ensure individualized family service plans include parental consent for telehealth methods of service.

SOURCE: CO Adopted Rule 5.113. (Accessed Aug. 2023).

Last updated 08/07/2023

Definitions

Telemedicine means the delivery of medical and health-care services and any diagnosis, consultation, or treatment using interactive audio (including but not limited to telephone and relay calls), interactive video (including but not limited to interactive audiovisual modalities), or interactive data communication (including but not limited to live chat and excluding text messaging, electronic mail, and facsimile transmission).

SOURCE: Colorado Adopted Rule 8.095.1.A. (Accessed Aug. 2023).

Telemedicine is not a unique service, but a means of providing services approved by Health First Colorado through live interactive audio and video telecommunications equipment.

SOURCE: CO Department of Health Care Policy and Financing. “Telemedicine Billing Manual,” (Accessed Aug. 2023).

Telemedicine is the delivery of medical services and any diagnosis, consultation, treatment, transfer of medical data or education related to health care services using interactive audio, interactive video or interactive data communication instead of in-person contact.

SOURCE: Colorado Adopted Rule 8.200.3.B (Accessed Aug. 2023).

“Telemedicine” means the delivery of medical and health-care services and any diagnosis, consultation, or treatment using interactive audio, interactive video, or interactive data communication.

SOURCE: Colorado Revised Statute 25.5.-4-103 (25.7) (Accessed Aug. 2023).

Telehealth remote monitoring services include the installation and on-going remote monitoring of clinical data through technologic equipment in order to detect minute changes in the client’s clinical status that will allow Home Health agencies to intercede before a chronic illness exacerbates requiring emergency intervention or inpatient hospitalization.

SOURCE: CO Medical Assistance Program, Home Health Billing Manual, (10/22), (Accessed Aug. 2023).

Telehealth allows for the monitoring of a member’s health status remotely via equipment, which transmits data from the member’s home to the member’s home health agency. The purpose of providing telehealth services is to assist in the effective management and monitoring of members whose medical needs can be appropriately and cost-effectively met at home through the frequent monitoring of data and early intervention.

SOURCE: CO Department of Health Care Policy and Financing. “Home Health Telehealth”. (Accessed Aug. 2023).

Home and Community-Based Services (HCBS)

Telehealth means the broad use of technologies to provide services and supports through HCBS waivers, when the Member is in a different location from the provider.

SOURCE: Colorado Adopted Rule 8.615.1 (M). (Accessed Aug. 2023).

Early Childhood Intervention Program

Telehealth means a method of service provision that utilizes secure interactive videoconferencing to deliver early intervention services.

SOURCE: 8 CCR 1405-1. (Accessed Aug. 2023).

Last updated 08/08/2023

Email, Phone & Fax

Telemedicine includes interactive audio (including but not limited to telephone and relay calls), interactive video (including but not limited to interactive audiovisual modalities), or interactive data communication (including but not limited to live chat and excluding text messaging, electronic mail, and facsimile transmission). Any health benefits provided through interactive audio, interactive video, or interactive data communication must meet the same standard of care as in-person care.

SOURCE: Colorado Adopted Rule 8.200.3.B. (Accessed Aug. 2023).

Telemedicine may be provided through interactive audio, interactive video, or interactive data communication, including but not limited to telephone, relay calls, interactive audiovisual modalities, and live chat as long as the technologies are compliant with HIPAA. The health care or mental health care services are subject to reimbursement policies developed pursuant to the medical assistance program. Reimbursement rate must be, at minimum, the same as a comparable in-person services.

SOURCE: CO Revised Statutes 25.5-5-320. (Accessed Aug. 2023).

No reimbursement for provider-to-provider consultations provided by telephone (interactive audio).

No reimbursement for FAX.

No reimbursement for email.

All rendering providers must bill the appropriate procedure code using Place of Service code 02 or 10 and the appropriate modifiers FQ or FR on the CMS 1500 paper claim form or as an 837P transaction.

Modifiers FQ, FR, 93, and 95 can be added to POS 2 and 10:

FQ: The service was furnished using audio-only communication technology.
FR: The supervising practitioner was present through two-way, audio/video communication technology.
93: Synchronous Telemedicine Service Rendered Via Telephone or Other Real-Time Interactive Audio-Only Telecommunications System
95: Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System

FQHCs/RHCs/IHS

Health First Colorado allows telemedicine visits to qualify as billable encounters for Federally Qualified Health Centers (FQHCs), Rural Health Clinic (RHCs), and Indian Health Services (IHS). Services allowed under telemedicine may be provided via telephone, live chat, or interactive audiovisual modality for these provider types.

Physical Therapy, Occupational Therapy, Home Health, Hospice and Pediatric Behavioral Health Providers

Physical therapists, occupational therapists, hospice, home health providers and pediatric behavioral health providers are eligible to deliver telemedicine services.

Home Health Agency services and therapies, Hospice, and Pediatric Behavioral Treatment may be provided via telephone-only.
Outpatient Physical, Occupational, and Speech Therapy services must have an interactive audio/visual connection with the member to be provided via telemedicine.

SOURCE: CO Department of Health Care Policy and Financing. “Telemedicine Billing Manual” 7/23. (Accessed Aug. 2023).

Behavioral Health

“Face-to-Face clinical assessment” means a formal and continuous process of collecting and evaluating information about an individual for service planning, treatment, referral, and funding eligibility as outlined in 21.190, and takes place at a minimum upon a request from the responsible person for funded services through the Children and Youth Mental Health Treatment Act. This information establishes justification for services and Children and Youth Mental Health Treatment Act funding. The child or youth must be physically in the same room as the professional person during the Face-to-Face clinical assessment. If the child is out of state or otherwise unable to participate in a Face- to-Face assessment, video technology may be used. If the Governor or local government declares an emergency or disaster, telephone may be used. Telephone shall only be used as necessary because of circumstances related to the disaster or emergency.

SOURCE: 2 CO Code of Regulation 502-1, 21.200.41, p. 37 (Accessed Aug. 2023).

Screening Brief Intervention Treatment

Screening Brief Intervention Treatment may be provided via telemedicine (simultaneous audio and video transmission or by telephone audio-only) with the member.

SOURCE: CO Department of Health Care Policy and Financing. “Screening, Brief Intervention and Referral to Treatment”, 3/23. (Accessed Aug. 2023).

Community Mental Health Centers/Clinics

Group psychotherapy services shall be face-to-face, or interactive audio (including but not limited to telephone and relay calls), interactive video (including but not limited to interactive audiovisual modalities), or interactive data communication (including but not limited to live chat and excluding text messaging, electronic mail, and facsimile transmission) services that are insight-oriented, behavior modifying, and that involve emotional interactions of the group members. Group psychotherapy services shall assist in providing relief from distress and behavior issues with other clients who have similar problems and who meet regularly with a practitioner. Any health benefits provided through interactive audio, interactive video, or interactive data communication must meet the same standard of care as in-person care.

Individual psychotherapy services shall be face-to-face, or interactive audio (including but not limited to telephone and relay calls), interactive video (including but not limited to interactive audiovisual modalities), or interactive data communication (including but not limited to live chat and excluding text messaging, electronic mail, and facsimile transmission) services that are tailored to address the individual needs of the client. Services shall be insight-oriented, behavior modifying and/or supportive with the client in an office or outpatient facility setting. Individual psychotherapy services are limited to thirty-five visits per State fiscal year. Any health benefits provided through interactive audio, interactive video, or interactive data communication must meet the same standard of care as in-person care.

SOURCE: Colorado Adopted Rule 8.750.3.B. (Accessed Aug. 2023).

Long Term Services and Supports (LTSS), Home and Community-based Services (HCBS), Services for Individuals with Intellectual and Developmental Disabilities, Early Childhood Intervention Services

Upon department approval, certain eligibility determinations, assessments, referrals, and monitoring contacts may be completed by case managers at an alternate location, via telephone or using virtual technology methods. Such approval may be granted for situations in which face-to-face meetings would pose a documented safety risk to the case manager or Client (e.g. natural disaster, pandemic, etc.).

SOURCE: 10 CCR 2505-10 8.393; 8.506.4.B; 8.508.70; 8.509; 8 CCR 1405-1. (Accessed Aug. 2023).

Adult Day Services (ADS)

Telehealth Adult Day Services are provided through virtual means in a group or on an individual basis. Telehealth ADS are ways for participants to engage in activities, with their community, and connect to staff and other ADS participants virtually or over the phone, only if a participant does not have access or the ability to use video chat technology. Services provided through Telehealth are not required to provide nutrition services. See rule for staffing, documentation, and written policy requirements specific to use of telehealth ADS.

SOURCE: 10 CCR 2505-10 8.491. (Accessed Aug. 2023).

Home Health Services

Services shall be provided in the client’s place of residence or one of the following places of service: Services may be provided using interactive audio (including but not limited to telephone and relay calls), interactive video (including but not limited to interactive audiovisual modalities), or interactive data communication (including but not limited to live chat and excluding text messaging, electronic mail, and facsimile transmission) instead of in-person contact. Any health benefits provided through interactive audio, interactive video, or interactive data communication must meet the same standard of care as in-person care.

SOURCE: Colorado Adopted Rule 8.520.4.B.g (Accessed Aug. 2023).

Family Planning Services

Eligible places of service include: Telemedicine, including interactive audio (including but not limited to telephone and relay calls), interactive video (including but not limited to interactive audiovisual modalities), or interactive data communication (including but not limited to live chat and excluding text messaging, electronic mail, and facsimile transmission). Any health benefits provided through interactive audio (including but not limited to telephone and relay calls), interactive video (including but not limited to interactive audiovisual modalities), or interactive data communication (including but not limited to live chat and excluding text messaging, electronic mail, and facsimile transmission) must meet the same standard of care as in-person care.

SOURCE: Colorado Adopted Rule 8.730.3.B. (Accessed Aug. 2023).

Last updated 08/07/2023

Live Video

POLICY

CO Medicaid will cover medically necessary medical and surgical services furnished to eligible members.

Telemedicine services may be provided under two arrangements.

The first arrangement is when a member receives services via a live audio/visual connection from a single provider. This is the predominant arrangement for telemedicine.
The second arrangement is when a member and a provider are physically in the same location and additional services are provided by a second (distant) provider via a live audio/visual connection. In this arrangement the provider who is present with the member is called the “originating provider”, and the provider located at a different site, acting as a consultant, is called the “distant provider”.

The member must be present during any Telemedicine visit.

It is acceptable to use Telemedicine to facilitate live contact directly between a member and a provider.

SOURCE: CO Department of Health Care Policy and Financing. “Telemedicine Billing Manual,” 7/23 (Accessed Aug. 2023).

In-person contact between a health care or mental health care provider and a patient is not required under the state’s medical assistance program for health care or mental health care services delivered through telemedicine that are otherwise eligible for reimbursement under the program. Any health care or mental health care service delivered through telemedicine must meet the same standard of care as an in-person visit. Telemedicine may be provided through interactive audio, interactive video, or interactive data communication, including but not limited to telephone, relay calls, interactive audiovisual modalities, and live chat as long as the technologies are compliant with HIPAA. The health care or mental health care services are subject to reimbursement policies developed pursuant to the medical assistance program. This section also applies to managed care organizations that contract with the state department pursuant to the statewide managed care system only to the extent that:

Health care or mental health care services delivered through telemedicine are covered by and reimbursed under the Medicaid per diem payment program; and
Managed care contracts with managed care organizations are amended to add coverage of health care or mental health care services delivered through telemedicine and any appropriate per diem rate adjustments are incorporated.

Reimbursement rate must be, at minimum, the same as a comparable in-person services.

SOURCE: CO Revised Statutes 25.5-5-320 (Accessed Aug. 2023).

Interim Therapeutic Restorations

In-person contact between a health care provider and a recipient is not required under the state’s medical assistance program for the diagnosis, development of a treatment plan, instruction to perform an interim therapeutic restoration procedure, or supervision of a dental hygienist performing an interim therapeutic restoration procedure. A health care provider may provide these services through telehealth, including store-and-forward transfer, and is entitled to reimbursement for the delivery of those services via telehealth to the extent the services are otherwise eligible for reimbursement under the program when provided in person. The services are subject to the reimbursement policies developed pursuant to the state medical assistance program.

SOURCE: CO Revised Statutes 25.5-5-321.5. (Accessed Aug. 2023).

ELIGIBLE SERVICES/SPECIALTIES

Colorado Medicaid will reimburse for medical and mental health services delivered through telemedicine that are otherwise eligible for reimbursement under the program.

Health care or mental health care services includes speech therapy, physical therapy, occupational therapy, hospice care, home health care and pediatric behavioral health care.

SOURCE: CO Revised Statutes 25.5-5-320. (Accessed Aug. 2023).

Services may be rendered via telemedicine when the service is:

A covered Health First Colorado benefit,
Within the scope and training of an enrolled provider’s license, and
Appropriate to be rendered via telemedicine.

All services provided through telemedicine shall meet the same standard of care as in-person care.

Refer to the Telemedicine Website for a list of billing codes which may be used with Place of Service (POS) 02 or 10.

The reimbursement rate for a telemedicine service shall, as a minimum, be set at the same rate as the medical assistance program rate for a comparable in-person service.

Providers may only bill procedure codes which they are already eligible to bill.

Place of Services codes 02 and 10 can be used during telehealth encounters:

POS 02: Telehealth provided other than in the patient’s home. The location where health services and health related services are provided or received, through telecommunication technology. Patient is not located in their home when receiving health services or health related services through telecommunication technology.
POS 10: Telehealth Provided in Patient’s Home. The location where health services and health related services are provided or received through telecommunication technology. Patient is located in their home (which is a location other than a hospital or other facility where the patient receives care in a private residence) when receiving health services or health related services through telecommunication technology.

Additionally, modifiers FQ, FR, 93, and 95 can be added to POS 2 and 10:

FQ: The service was furnished using audio-only communication technology.
FR: The supervising practitioner was present through two-way, audio/video communication technology.
93: Synchronous Telemedicine Service Rendered Via Telephone or Other Real-Time Interactive Audio-Only Telecommunications System
95: Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System

SOURCE: CO Department of Health Care Policy and Financing. “Telemedicine – Provider Information”, CO Department of Health Care Policy and Financing, CO Department of Health Care Policy and Financing. “Telemedicine Billing Manual”, 7/23. (Accessed Aug. 2023).

Physician services may be provided as telemedicine. Any health benefits provided through telemedicine shall meet the same standard of care as in-person care.

SOURCE: Colorado Adopted Rule 8.200.3.B. (Accessed Aug. 2023).

Any Health First Colorado-covered physician services that are within the scope of a provider’s practice and training and appropriate for telemedicine may be rendered via telemedicine.

SOURCE: CO Department of Health Care Policy and Financing. “Telemedicine – Provider Information”. (Accessed Aug. 2023).

Procedure codes listed below under “Telemedicine Modifier GT” will receive an additional $5.00 to the fee listed on the most recent Health First Colorado Fee Schedule when billed using modifier GT.

SOURCE: CO Department of Health Care Policy and Financing. “Telemedicine Billing Manual” 7/23. (Accessed Aug. 2023).

All Colorado Medicaid clients are eligible for medical and behavioral services delivered by telemedicine.

Covered Telemedicine services must:

Meet the same standard of care as in-person care;
Be compliant with state and federal regulations regarding care coordination;
Be services the Department has approved for delivery through Telemedicine;
Be within the provider’s scope of practice and for procedure codes the provider is already eligible to bill;
Be provided only where contact with the provider was initiated by the member for the services rendered; and
Be provided only after the member’s consent, either verbal or written, to receive telemedicine services is documented.

The reimbursement rate for a Telemedicine service shall, as a minimum, be set at the same rate as the Colorado Medicaid rate for a comparable in-person service.

SOURCE: Colorado Adopted Rule 8.095.2, 8.095.4, 8.095.7. (Accessed Aug. 2023).

Durable Medical Equipment Encounters

Face-to-face encounters for durable medical equipment, prosthetics, orthotics, and supplies may be performed via telehealth if available.

SOURCE: CO Department of Health Care Policy and Financing. “Durable Medical Equipment, Prosthetics, Orthotics, and Supplies”, 7/23. (Accessed Aug. 2023).

Certain providers are authorized to order durable medical equipment and may conduct a related face-to-face encounter via telehealth or telemedicine if those services are covered by the Medical Assistance Program.

SOURCE: Colorado Adopted Rule 8.590.7.N. (Accessed Aug. 2023).

Pediatric Behavioral Therapy

Pediatric Behavioral Therapists are covered under the telemedicine policy.

SOURCE: CO Department of Health Care Policy and Financing. “Pediatric Behavioral Therapies Billing Manual”, 1/23 (Accessed Aug. 2023).

Pediatric Behavioral Therapy (PBT) providers will not be required to collect Electronic Visit Verification (EVV) data when the services are delivered via telehealth, effective May 1, 2023. EVV remains a requirement for all other PBT services when delivered in the home or community.

SOURCE: CO Dept. of Health Care Policy and Financing. Provider Bulletin. May 2023. (Accessed Aug. 2023).

Screening Brief Intervention Treatment

Screening Brief Intervention Treatment may be provided via telemedicine (simultaneous audio and video transmission or by telephone audio-only) with the member.

SOURCE: CO Department of Health Care Policy and Financing. “Screening, Brief Intervention and Referral to Treatment”, 3/23. (Accessed Aug. 2023).

Education-Only Services

Colorado Medicaid provides reimbursement for education-only services provided through telemedicine. This includes services such as Diabetes Self-Management Education and Support (DSMES) and tobacco cessation counseling.

SOURCE: CO Department of Health Care Policy and Financing. Provider Bulletin B1900434. Aug. 2019. (Accessed Aug. 2023).

Education-only services was removed from the list of “Not Covered Services” section in the provider manual in June 2019.

SOURCE: CO Department of Health Care Policy and Financing. “Telemedicine Billing Manual” 7/23. (Accessed Aug. 2023).

Abortion Services

Certain medicinal abortion services may be provided by telemedicine. Physicians (MDs/DOs), Certified Nurse Midwives (CNMs), Advanced Practice Nurses (APNs) or Physician Assistants (PAs) who wish to prescribe Mifepristone must complete a Prescriber Agreement Form prior to ordering and dispensing Mifepristone. The medicinal abortion method (not available for use in maternal life-endangering situations) can be provided by these identified provider types and identified places of service effective May 21, 2021, when prescribed or dispensed and provided by eligible Mifepristone-prescribing practitioners.

HCPCS S0199 covers:

Office visit #1 or telemedicine counseling/communications
- Patient check-in or telemedicine services, all counseling and consultation
- Confirmation of pregnancy and fetal gestational age (either by hCG or ultrasound)
Follow-up, may include a second office visit or consultation via telemedicine
- Patient consultation: may include telemedicine consult or office visit check-in with in-person consult.
- Confirmation of pregnancy termination (either by hCG or ultrasound)

Please see Provider Bulletin for further billing information and related requirements.

SOURCE: CO Department of Health Care Policy and Financing. Provider Bulletin B2200472. Jan. 2022. (Accessed Aug. 2023).

Community Mental Health Centers/Clinics

SOURCE: Colorado Adopted Rule 8.750.3.B. (Accessed Aug. 2023).

FQHC/RHC

When a Federally Qualified Health Center or a Rural Health Clinic provides care through telemedicine, the claim must include the modifier GT on line(s) identifying the service(s).

When used by an FQHC or RHC, the modifier GT identifies the services as being delivered through telemedicine modality. There is no enhanced payment to FQHCs and RHCs when using the modifier GT.

SOURCE: CO Department of Health Care Policy and Financing. “Telemedicine Billing Manual” 7/23. (Accessed Aug. 2023).

For Health First Colorado a billable encounter at an FQHC is an in person or telemedicine face to face visit with a Health First Colorado member.

Telemedicine services are limited to the procedure codes identified on the Telemedicine-Provider Information web page at the Provider Telemedicine web page.

When a Federally Qualified Health Center or a Rural Health Clinic provides care through telemedicine, the claim must include the modifier GT on line(s) identifying the service(s).

Additionally, modifiers FQ and FR can be added to the claim:

FQ: The service was furnished using audio-only communication technology.
FR: The supervising practitioner was present through two-way, audio/video communication technology.

SOURCE: CO FQHC & RHC Billing Manual 8/22. (Accessed Aug. 2023).

The visit definition for a FQHC includes interactive audio (including but not limited to telephone and relay calls), interactive video (including but not limited to interactive audiovisual modalities), or interactive data communication (including but not limited to live chat and excluding text messaging, electronic mail, and facsimile transmission) encounters. Any health benefits provided through interactive audio (including but not limited to telephone and relay calls), interactive video (including but not limited to interactive audiovisual modalities), or interactive data communication (including but not limited to live chat and excluding text messaging, electronic mail, and facsimile transmission) must meet the same standard of care as in-person care.

SOURCE: Colorado Adopted Rule 8.700.1. (Accessed Aug. 2023).

Visit for a RHC means a face-to-face encounter, or an interactive audio (including but not limited to telephone and relay calls), interactive video (including but not limited to interactive audiovisual modalities), or interactive data communication (including but not limited to live chat and excluding text messaging, electronic mail, and facsimile transmission) encounter between a clinic client and any health professional providing the services set forth in 8.740.4. Any health benefits provided through interactive audio, interactive video, or interactive data communication must meet the same standard of care as in-person care.

SOURCE: Colorado Adopted Rule 8.740.1. (Accessed Aug. 2023).

Long Term Services and Supports (LTSS), Home and Community-based Services (HCBS), Services for Individuals with Intellectual and Developmental Disabilities, Early Childhood Intervention Services

SOURCE: 10 CCR 2505-10 8.393; 8.506.4.B; 8.508.70; 8.509; 8 CCR 1405-1. (Accessed Aug. 2023).

Home and Community-Based Services

Home and Community-Based Services Telehealth (HCBS Telehealth)is a method of service delivery of certain HCBS services listed at Section 8.615.2.

SOURCE: 10 CCR 2505-10 8.615.1 (M). (Accessed Aug. 2023).

Adult Day Services (ADS)

SOURCE: 10 CCR 2505-10 8.491. (Accessed Aug. 2023).

Mobile Crisis Response (MCR) Services

MCR services may be provided via Telemedicine in accordance with Section 8.095 by any one (1) member of the MCR provider’s team, where appropriate. The initial Telemedicine face-to-face crisis response must include at least (1) in-person responder from the MCR team.

SOURCE: 10 CCR 2505-10 8.020. (Accessed Aug. 2023).

ELIGIBLE PROVIDERS

Any licensed provider enrolled with Colorado Medicaid is eligible to provide telemedicine services within the scope of the provider’s practice.

SOURCE: Colorado Adopted Rule 8.095.3. CO Department of Health Care Policy and Financing. “Telemedicine Billing Manual” 7/23.(Accessed Aug. 2023).

The following distant provider types may bill using modifier GT:

Physician
Clinic
Osteopath
FQHC
Doctorate Psychologist
MA Psychologist
Physician Assistant
Nurse Practitioner
RHC

A primary care provider (PCP) is eligible to be reimbursed as the ‘originating provider’ when present with the patient. In order for a PCP to be reimbursed as a distant provider, the PCP must be able to facilitate an in-person visit in the state of CO if necessary for treatment of the member’s condition.

A specialist is eligible to be an originating provider (if present with the patient) or distant provider.

The distant provider may participate in the telemedicine interaction from any appropriate location.

When the patient is located in a hospital, please use the appropriate place of service code for where the patient is located.

SOURCE: CO Department of Health Care Policy and Financing. “Telemedicine Billing Manual” 7/23. (Accessed Aug. 2023).

Health First Colorado has expanded the list of providers eligible to deliver telemedicine services to include FQHCs, RHCs, IHS, physical therapists, occupational therapists, home health providers, hospice and pediatric behavioral health providers. Outpatient physical, occupational and speech therapy services must have an interactive audio/visual connection with the member to be provided via telemedicine.

SOURCE: CO Dept. of Health Care Policy and Financing, Provider Bulletin, June 2023. (Accessed Aug. 2023).

A telemedicine service meets the definition of a face-to-face encounter for a rural health clinic, Indian health service, or federally qualified health center. The reimbursement rate for a telemedicine service provided by a rural health clinic or federal Indian health service or federally qualified health center must be set at a rate that is no less than the medical assistance program rate for a comparable face-to-face encounter or visit.

SOURCE: CO Statute, Sec. 25.5-5-320. (Accessed Aug. 2023).

eHealth Entities

Providers that meet the definition of an eHealth Entity shall enroll as the eHealth specialty. Electronic Health Entity (eHealth Entity) means a group practice that delivers services exclusively through telemedicine and is enrolled in a provider type that has an eHealth specialty. eHealth entities:

1. Cannot be Primary Care Medical Providers
  1. Primary Care Medical Provider (PCMP) means an individual physician, advanced practice nurse or physician assistant, who contracts with a Regional Accountable Entity (RAE) in the Accountable Care Collaborative (ACC), with a focus on primary care, general practice, internal medicine, pediatrics, geriatrics, or obstetrics and gynecology.
2. Can be either in-state or out-of-state.

eHealth Entities shall only provide Covered Telemedicine services, including Facilitated Visits. A Facilitated Visit means a Telemedicine visit where the rendering provider is at a distant site and the member is physically present with a support staff team member who can assist the provider with in-person activities. eHealth Entities must maintain a Release of Information in compliance with current HIPAA standards to facilitate communication with the member’s PCMP.

SOURCE: Colorado Adopted Rule 8.095.1, 8.095.3, 8.095.4, 8.095.6. (Accessed Aug. 2023).

As of October 30th, 2022, there is a provider specialty type for Clinic and Non-Physician Practitioner groups that meet the following definition:

An eHealth entity is defined as a group practice that delivers services exclusively through telemedicine and is enrolled in a provider type that has an eHealth specialty. Providers who meet this definition must update their enrollment to this provider specialty type.

SOURCE: CO Department of Health Care Policy and Financing. “Telemedicine Billing Manual” 7/23. (Accessed Aug. 2023).

The telemedicine rule 10 CCR 2505-10 8.095 regarding eHealth entities is effective as of October 30, 2022. An eHealth entity is defined as a group practice that delivers services exclusively through telemedicine and is enrolled in a provider type that has an eHealth specialty.

Telemedicine-only providers are to use Specialty Code 878.
Telemedicine and in-person providers will continue to use the appropriate specialty code for their chosen provider type.

SOURCE: CO Department of Health Care Policy and Financing, Health First CO Provider Bulleting B2200485, (Nov. 2022), (Accessed Aug. 2023).

ELIGIBLE SITES

If no originating provider is present during a Telemedicine Services appointment, then the location of the originating site is at the member’s discretion and can include the member’s home. However, members can be required to choose a location suitable to delivery of telemedicine services that may include adequate lighting and environmental noise levels suitable for easy conversation with a provider.

Services can be provided via telemedicine between a member and a distant provider when a member is located in their home or other location of their choice.

A specialist is eligible to be an originating provider (if present with the patient) or distant provider.

If practitioners at both the originating site and the distant site provide the same service to the member, both providers submit claims using the same procedure code with modifier 77 (Repeat procedure by another physician).

SOURCE: CO Department of Health Care Policy and Financing. “Telemedicine Billing Manual” 7/23. (Accessed Aug. 2023).

Telemedicine can work:

From a provider office: You can connect through video with a provider in another office. Both offices must have telemedicine equipment.
From your home or other location like a library: You may be able to use your mobile phone, tablet or desktop computer to connect to a provider. Health First Colorado will not pay for the equipment.

SOURCE: CO Department of Health Care Policy and Financing. “Telemedicine”. (Accessed Aug. 2023).

Eligible place of service includes Telemedicine, including interactive audio (including but not limited to telephone and relay calls), interactive video (including but not limited to interactive audiovisual modalities), or interactive data communication (including but not limited to live chat and excluding text messaging, electronic mail, and facsimile transmission). Any health benefits provided through interactive audio (including but not limited to telephone and relay calls), interactive video (including but not limited to interactive audiovisual modalities), or interactive data communication (including but not limited to live chat and excluding text messaging, electronic mail, and facsimile transmission) must meet the same standard of care as in-person care.

SOURCE: Colorado Adopted Rule 8.200.3.B.3.D.2.c.7 (Accessed Aug. 2023).

Speech Therapy

Telemedicine POS 02 and Telehealth POS 10 are allowed place of service codes.

SOURCE: CO Department of Health Care Policy and Financing. “Speech Therapy”, 3/23. (Accessed Aug. 2023).

Therapy Providers

POS Code 02 or 10 should be used to report services delivered via telecommunication depending on the location of the member when receiving telehealth services. POS 02 is used when the member is receiving telehealth service in a place that is not their home. POS 10 is used when a member is receiving telehealth services when the member is located in their home.

Outpatient physical, occupational, and speech therapy services must have an interactive audio/visual connection with the member to be provided via telemedicine.

SOURCE: CO Department of Health Care Policy and Financing. Provider Bulletin B2200480. July 2022. (Accessed Aug. 2023).

Home Health Services

SOURCE: Colorado Adopted Rule 8.520.4.B.g (Accessed Aug. 2023).

Telehealth monitoring is available for members who are eligible through the Home Health benefit and should not be billed as telemedicine. Providers rendering telehealth monitoring should consult the Home Health Billing Manual on the Billing Manuals web page under the CMS 1500 drop-down.

SOURCE: CO Department of Health Care Policy and Financing. “Telemedicine Billing Manual” 7/23. (Accessed Aug. 2023).

Family Planning Services

SOURCE: Colorado Adopted Rule 8.730.3.B. (Accessed Aug. 2023).

GEOGRAPHIC LIMITS

No Reference Found.

FACILITY/TRANSMISSION FEE

In some cases, the originating provider site will not be providing clinical services, but only providing a site and telecommunications equipment. In this situation, the telemedicine originating site facility fee is billed using procedure code Q3014.

Originating providers bill as follows:

If the originating provider is making a room and telecommunications equipment available but is not providing clinical services, the originating provider bills Q3014 (the procedure code for the telemedicine originating site facility fee).
If the originating provider also provides clinical services to the member, the provider bills the rendering provider’s appropriate procedure code and bills Q3014.
The originating provider may also bill, as appropriate, on the UB-04 paper claim form or as an 837I transaction for any clinical services provided on-site on the same day that a telemedicine originating site claim is made. The originating provider must submit two separate claims for the member’s two separate services.

Providers eligible for the originating site facility fee include:

Physician
Clinic
Osteopath
FQHC
Doctorate Psychologist
MA Psychologist
Physician Assistant
Nurse Practitioner
RHC

Provider types not listed above may facilitate Telemedicine Services with a distant provider but may not bill procedure code Q3014. Examples include Nursing Facilities, Intermediate Care Facilities, Assisted Living Facilities, etc.

Using modifier GT with specific codes adds $5.00 to the fee listed for the service. A specific list of eligible codes is provided in the manual. Other codes can be billed, but don’t pay the telemedicine transmission fee.

SOURCE: CO Department of Health Care Policy and Financing. “Telemedicine Billing Manual” 7/23. (Accessed Aug. 2023).

The state department shall establish rates for transmission cost reimbursement for telemedicine services, considering, to the extent applicable, reductions in travel costs by health care or mental health care providers and patients to deliver or to access such services and such other factors as the state department deems relevant.

SOURCE: CO Revised Statutes 25.5-5-320(3). (Accessed Aug. 2023).

Last updated 08/08/2023

Miscellaneous

Services appropriately billed to managed care should continue to be billed to managed care. All managed care requirements must be met for services billed to managed care. Managed care may or may not reimburse telemedicine costs.

SOURCE: CO Department of Health Care Policy and Financing. “Telemedicine Billing Manual” 7/23. (Accessed Aug. 2023).

All Health First Colorado providers using telemedicine to deliver Health First Colorado services must employ existing quality-of-care protocols and member confidentiality guidelines when providing telemedicine services. Health benefits provided through telemedicine must meet the same standard of care as in-person care. Record-keeping should comply with Health First Colorado requirements in 10 CCR 2505-10, Section 8.130.2.

Transmissions must be performed on dedicated secure lines or must utilize an acceptable method of encryption adequate to protect the confidentiality and integrity of the transmission. Transmissions must employ acceptable authentication and identification procedures by both the sender and the receiver. Providers of telemedicine services must implement confidentiality procedures that include, but are not limited to:

Specifying the individuals who have access to electronic records.
Using unique passwords or identifiers for each employee or other person with access to the member records.
Ensuring a system to routinely track and permanently record such electronic medical information.
Members must be advised of their right to privacy and that their selection of a location to receive telemedicine services in private or public environments is at the member’s discretion.

SOURCE: CO Department of Health Care Policy and Financing. “Telemedicine Billing Manual” 7/23. (Accessed Aug. 2023).

Specialty Code 878 is a new code that will be added to the Colorado interChange for Provider Types 16 (Clinic) and 25 (Non-Practitioner). Telemedicine only providers are to use Specialty Code 878. Telemedicine and in-person providers will continue to use the appropriate specialty code for their chosen provider type. Providers choosing telemedicine can only have one specialty. The telemedicine specialty does not allow Primary Care Medical Provider (PCMP) enrollment with a Regional Accountable Entity (RAE).

SOURCE: CO Department of Health Care Policy and Financing. Provider News, Issue 48. May 2022. (Accessed Aug. 2023).

Rural Provider Access and Affordability Stimulus Grant Program

Pursuant to C.R.S. § 25.5-1-207, the Rural Provider Access and Affordability Stimulus Grant Program provides grants to qualified providers to improve health care affordability and access to health care services in rural communities and to drive financial sustainability for rural hospitals and clinics. Rural Stimulus Grant funds must be used for Health Care Affordability Projects or Health Care Access Projects to improve health care affordability and access in Rural Communities.

Health Care Access Project means a project that expands access to health care in Rural Communities including but not limited to expanding access to Telemedicine including remote monitoring support.
Health Care Affordability Project means a project that modernizes the information technology infrastructure of Qualified Rural Providers including but not limited to enabling technologies, including telehealth and e-consult systems, that allow Qualified Rural Providers to communicate, share clinical information, and consult electronically to manage patient care.

SOURCE: 10 CCR 2505-10 8.8000. (Accessed Aug. 2023).

Veterans Mental Health Services Program

There is established in the Division of Veterans Affairs a veterans mental health services program to promote access to mental health services for eligible veterans by reimbursing providers for sessions with an eligible veteran. The division shall reimburse providers who participate in the program for mental health-care sessions, either in person or by telehealth, with eligible veterans. Each eligible veteran may receive twenty-six reimbursed sessions per year. Subject to available appropriations, an eligible veteran may receive, and the division shall reimburse a provider for, additional reimbursed sessions if a provider determines additional sessions are necessary. The division shall determine a reasonable rate of reimbursement for each mental health-care session with an eligible veteran pursuant to the program, which rate must be the same regardless of whether the appointment is for a telehealth or an in-person appointment.

SOURCE: Colorado Revised Statutes 28-5-714. (Accessed Aug. 2023).

Last updated 08/08/2023

Out of State Providers

Any licensed provider enrolled with Colorado Medicaid is eligible to provide telemedicine services within the scope of the provider’s practice. Providers that meet the definition of an eHealth Entity shall enroll as the eHealth specialty.

Electronic Health Entity (eHealth Entity) means a group practice that delivers services exclusively through telemedicine and is enrolled in a provider type that has an eHealth specialty. eHealth entities:

1. Cannot be Primary Care Medical Providers
  1. Primary Care Medical Provider (PCMP) means an individual physician, advanced practice nurse or physician assistant, who contracts with a Regional Accountable Entity (RAE) in the Accountable Care Collaborative (ACC), with a focus on primary care, general practice, internal medicine, pediatrics, geriatrics, or obstetrics and gynecology
2. Can be either in-state or out-of-state.

SOURCE: CO Adopted Rule 8.095.1, 8.095.3. (Accessed Aug. 2023).

Last updated 08/07/2023

Overview

Colorado Medicaid reimburses for live video for medical and mental health services. They also provide reimbursement for remote patient monitoring for patients with certain chronic conditions. Colorado Medicaid requires a member to be present and participating in a telemedicine service, excluding the possibility of utilizing store-and-forward, except in the case of teledentistry for an interim therapeutic restoration.

Last updated 08/08/2023

Remote Patient Monitoring

POLICY

Telehealth monitoring is available for members who are eligible through the Home Health benefit and should not be billed as telemedicine.

SOURCE: CO Department of Health Care Policy and Financing. “Telemedicine Billing Manual” 7/23. (Accessed Aug. 2023).

The CO Medical Assistance Program will reimburse for home health care or home and community-based services through telemedicine at a flat fee set by the state board.

SOURCE: CO Revised Statutes 25.5-5-321. (Accessed Aug. 2023)

Home care agencies and home care placement agencies rules must allow for supervision in person or be telemedicine or telehealth. Any rules adopted by the board shall be in conformity with applicable federal law and must take into consideration the appropriateness, suitability and necessity of the method of supervision permitted.

SOURCE: CO Revised Statutes 25-27.5-104. (Accessed Aug. 2023).

The Home Health Agency shall create policies and procedures for the use and maintenance of the monitoring equipment and the process of telehealth monitoring. The Home Health Agency shall provide monitoring equipment that possesses the capability to measure any changes in the monitored diagnoses and meets all the safety requirements in the regulation. Home Health Telehealth services are covered for clients receiving Home Health Services for telehealth monitoring.

SOURCE: 10 CO Code of Regulation 2505-10 8.520.5.D. (Accessed Aug. 2023).

CO Medicaid reimburses telehealth remote monitoring services including installation and on-going remote monitoring of clinical data through technologic equipment in order to detect minute changes in the member’s clinical status that will allow Home Health agencies to intercede before a chronic illness exacerbates requiring emergency intervention or inpatient hospitalization.

SOURCE: CO Medical Assistance Program, Home Health Billing Manual, (10/22), (Accessed Aug. 2023).

CO Medicaid covers home health telehealth, which includes frequent and ongoing self-monitoring of members through equipment left in the member’s home which is designed to measure the common signs and symptoms of disease exacerbation before a crisis occurs allowing for timely intervention and symptom management.

SOURCE: CO Department of Health Care Policy and Financing. “Home Health Telehealth”. (Accessed Aug. 2023).

CONDITIONS

A member is eligible only if they meet the following criteria:

Member must receive Home Health services from provider who has opted to provide telehealth services
Member must require frequent and on-going monitoring/management of their disease or condition
Member’s home environment must be compatible with the use of the equipment
Member or caregiver must be willing and able to comply with vital sign self-monitoring
Member must have one or more of the following diagnoses:
1. Congestive Heart Failure
2. Chronic Obstructive Pulmonary Disease
3. Asthma
4. Diabetes
5. Other diagnosis or condition deemed appropriate by the Department or its designee

SOURCE: CO Department of Health Care Policy and Financing. “Home Health Telehealth”. (Accessed Aug. 2023).

The following requirements must be met:

Client is receiving services from a home health provider for at least one of the following: congestive heart failure, chronic obstructive pulmonary disease, asthma, or diabetes, pneumonia; or other diagnosis or medical condition deemed eligible by the Department or its Designee.
Client requires ongoing and frequent, minimum of 5 times weekly, monitoring to manage their qualifying diagnosis, as defined and ordered by a physician or podiatrist;
Client has demonstrated a need for ongoing monitoring as evidenced by having been hospitalized two or more times in the last twelve months for conditions related to the qualifying diagnosis; or, if the client has received home health services for less than six months, the client was hospitalized at least once in the last three months, an acute exacerbation of a qualifying diagnosis that requires telehealth monitoring, or new onset of a qualifying disease that requires ongoing monitoring to manage the client in their residence;
Client or caregiver misses no more than 5 transmissions of the provider and agency prescribed monitoring events in a thirty-day period; and
Client’s home environment has the necessary connections to transmit the telehealth data to the agency and has space to set up and use the equipment as prescribed.

SOURCE: 10 CO Code of Regulation 2505-10 8.520.5.D. (Accessed Aug. 2023).

PROVIDER LIMITATIONS

Any home health agency is eligible to provide services. A specific list of agencies providing these services via telehealth is listed.

SOURCE: CO Department of Health Care Policy and Financing. “Home Health Telehealth”. (Accessed Aug. 2023).

Acute home health agencies and long-term home health agencies are reimbursed for the initial installation and education of telehealth monitoring equipment and can be billed once per client per agency. The agency can also bill for every day they receive and review the client’s clinical information.

No prior authorization needed, but agencies should notify the Department or its designee when a client is enrolled in the service.

SOURCE: CO Medical Assistance Program, Home Health Billing Manual, (10/22), (Accessed Aug. 2023).

OTHER RESTRICTIONS

Home Health services are covered under Medicaid only when all of the following are met:

Services are medically necessary.
Services are provided under a plan of care as defined at Section 8.520.1 DEFINITIONS.
Services are provided on an intermittent basis, as defined at Section 8.520.1, DEFINITIONS.
The client meets one of the following:
1. The only alternative to Home Health services is hospitalization or emergency room care; or
2. Client’s medical records indicate that medically necessary services should be provided in the client’s home instead of other out-patient setting, according to one or more of the following guidelines:
  1. The client, due to illness, injury or disability, is unable to travel to an outpatient setting for the needed service;
  2. Based on the client’s illness, injury, or disability, travel to an outpatient setting for the needed service would create a medical hardship for the client;
  3. Travel to an outpatient setting for the needed service is contraindicated by a documented medical diagnosis;
  4. Travel to an outpatient setting for the needed service would interfere with the effectiveness of the service; or
  5. The client’s medical diagnosis requires teaching which is most effectively accomplished in the client’s place of residence on a short-term basis.
The client is unable to perform the health care tasks for him or herself, and no unpaid family/caregiver is able and willing to perform the tasks; and
Covered service types are those listed in Service Types, Section 8.520.5.

SOURCE: 10 CO Code of Regulation 2505-10 8.520.4.A. (Accessed Aug. 2023).

Last updated 08/07/2023

Store and Forward

POLICY

The member must be present during any Telemedicine visit.

SOURCE: CO Department of Health Care Policy and Financing. “Telemedicine Billing Manual” 7/23. (Accessed Aug. 2023).

SOURCE: Colorado Adopted Rule 8.200.3.B. (Accessed Aug. 2023).

SOURCE: CO Revised Statutes 25.5-5-320. (Accessed Aug. 2023).

In-person contact between a health care provider and a recipient is not required under the state’s medical assistance program for the diagnosis, development of a treatment plan, instruction to perform an interim therapeutic restoration procedure, or supervision of a dental hygienist performing an interim therapeutic restoration procedure. A health care provider may provide these services through store-and-forward transfer and is entitled to reimbursement for the delivery of those services via telehealth to the extent the services are otherwise eligible for reimbursement under the program when provided in-person. The services are subject to the reimbursement policies developed pursuant to the state medical assistance program.

SOURCE: CO Revised Statutes 25.5-5-321.5. (Accessed Aug. 2023).

ELIGIBLE SERVICES/SPECIALTIES

Limited reimbursement allowed for an interim therapeutic restoration in teledentistry.

SOURCE: CO Revised Statutes 25.5-5-321.5. (Accessed Aug. 2023).

GEOGRAPHIC LIMITS

No Reference Found

FACILITY/TRANSMISSION FEE

No Reference Found

Professional Requirements

Last updated 08/08/2023

Cross State Licensing

Mental Health Providers

Limited licensure exemptions exist in CO Revised Statutes for certain mental health providers, including out-of-state practitioners as follows:

A person who resides in another state and who is currently licensed or certified as a psychologist, marriage and family therapist, clinical social worker, professional counselor, or addiction counselor in that state to the extent that the licensed or certified person performs activities or services in this state, if the activities and services are:

Performed within the scope of the person’s license or certification;
Do not exceed twenty days per year in this state;
Are not otherwise in violation of this article 245; and
Disclosed to the public that the person is not licensed or certified in this state

SOURCE: Colorado Revised Statutes 12-245-217. (Accessed Aug. 2023).

Colorado Medical Board

Providers who evaluate, treat or prescribe through telehealth technologies are practicing medicine. The practice of medicine occurs where the patient is located at the time telehealth technologies are used. Therefore, a provider must be licensed to practice medicine in the state of Colorado in order to evaluate or treat patients located in Colorado utilizing telehealth technologies or otherwise.

SOURCE: The Colorado Medical Board Policies, 40-27, page 101. Guidelines for the Appropriate Use of Telehealth Technologies in the Practice of Medicine. 8/19/21. (Accessed Aug. 2023).

Colorado Mental Health Boards

Providers who evaluate or treat through teletherapy technologies are practicing psychotherapy. The practice of psychotherapy occurs where the patient is located at the time teletherapy technologies are used. Therefore, a provider must be licensed, certified, or registered to practice psychotherapy in the state of Colorado in order to evaluate or treat patients located in Colorado utilizing teletherapy technologies or otherwise.

SOURCE: State Board of Psychologist Examiners Policies, 30-1, page 11. Teletherapy Policy – Guidance regarding Psychotherapy through Electronic Means. 2/2/18. (Accessed Aug. 2023).

Last updated 08/08/2023

Definitions

“Telemedicine” means the delivery of medical services through technologies that are used in a manner that is compliant with HIPAA, including information, electronic, and communication technologies, remote monitoring technologies, and store-and-forward transfers, to facilitate the assessment, diagnosis, consultation, or treatment of a patient while the patient is located at an originating site and the person who provides the services is located at a distant site.

SOURCE: CO Revised Statutes 12-240-104(6), (Accessed Aug. 2023).

“Telepsychology” means the provision of psychological services using telecommunications technologies.

SOURCE: CO Revised Statutes 12-245-301(6). (Accessed Aug. 2023).

Colorado Medical Board

“Telehealth” means a mode of delivery of health care services through HIPAA-compliant telecommunications systems, including information, electronic, and communication technologies, remote monitoring technologies, and store-and-forward transfers, to facilitate the assessment, diagnosis, consultation, treatment, education, care management, or self-management of a covered person’s health care while the person is located at an originating site and the provider is located at a distant site.

“Telehealth” includes “Telemedicine” as defined in section 12-240-104(6), C.R.S. This policy defines “telehealth” for purposes of compliance with the Medical Practice Act. Telehealth may be defined differently in different statutory contexts, including but not limited to, insurance requirements or reimbursement.

“Telehealth technologies” means technologies and devices enabling secure electronic communications and information exchange between a licensee in one location and a patient in another location with or without an intervening healthcare provider.

SOURCE: The Colorado Medical Board Policies, 40-27, page 100. Guidelines for the Appropriate Use of Telehealth Technologies in the Practice of Medicine. 8/19/21. (Accessed Aug. 2023).

Occupational Therapy

Telehealth means the use of electronic information and telecommunications technology to support and promote access to clinical health care, client and professional health-related education, public health and health administration.

Telerehabilitation or teletherapy means the delivery of rehabilitation and habilitation services via information and communication technologies, commonly referred to as “telehealth” technologies.

SOURCE: CO Revised Statute 12-270-104 (13) & (14). (Accessed Aug. 2023).

Behavioral Health Entities

Telehealth means delivery of services through telecommunications systems that are compliant with all federal and state protections of client privacy, to facilitate client assessment, diagnosis, consultation, treatment, and/or service planning/case management when the client and the individual providing BHE services are not in the same location. Telecommunications systems used to provide telehealth include information, electronic, and communication technologies.

SOURCE: 6 CO Regs. Rule 1011-1. Chap. 3, 1.3.36. (Accessed Aug. 2023).

General Hospitals

SOURCE: 6 CO Regs. Rule 1011-1. Ch. 4, Sec. 2. (Accessed Aug. 2023).

Nursing Care Facilities

“Telehealth” means a mode of delivery of health care services through telecommunication systems, including information, electronic, and communication technologies, to facilitate the assessment, diagnosis, consultation, treatment, education and care management of a resident’s health care when the resident and practitioner are located at different sites. Telehealth includes ‘telemedicine’ as defined in Section 12-36-102.5(8), C.R.S.”

SOURCE: 6 CO Regs. Rule 1011-1. Ch. 5, Sec. 2. (Accessed Aug. 2023).

Colorado Mental Health Boards

“Teletherapy” means a mode of delivery of mental health services through telecommunications systems, including information, electronic, and communication technologies, to facilitate the assessment, diagnosis, treatment, education, care management, or self-management of a person’s mental health care while the person is located at an originating site and the provider is located at a distant site. The term includes synchronous interactions and store-and-forward transfers.

This policy defines “telehealth” for purposes of compliance with the Mental Health Practice Act. Teletherapy may be defined differently in different statutory contexts, including but not limited to, insurance requirements or reimbursement.

“Teletherapy technologies” means technologies and devices enabling secure electronic communications and information exchange between a licensed, certified, or registered mental health professional in one location and a patient in another location with or without an intervening mental health care provider.

SOURCE: State Board of Psychologist Examiners Policies, 30-1, page 10. Teletherapy Policy – Guidance regarding Psychotherapy through Electronic Means. 2/2/18. (Accessed Aug. 2023).

Last updated 08/08/2023

Licensure Compacts

Member of the Interstate Medical Licensure Compact.

SOURCE: Interstate Medical Licensure Compact. The IMLC. (Accessed Aug. 2023).

Member of the Interjurisdictional Psychology Compact.

SOURCE: Compact of the Association of State and Provincial Psychology Boards. Legislative Updates. (Accessed Aug. 2023).

Member of the Physical Therapy Compact.

SOURCE: Physical Therapy Compact. Compact Map. (Accessed Aug. 2023).

Member of the Nurse Licensure Compact.

SOURCE: Current NLC States & Status. Nurse Licensure Compact. (Accessed Aug. 2023).

Member of the EMS Compact.

SOURCE: EMS Compact Map. (Accessed Aug. 2023).

Enacted Occupational Therapy Interstate Compact.

SOURCE: HB 21-1279 (2021 Session). OT Compact. (Accessed Aug. 2023).

Enacted Audiology and Speech-Language Interstate Compact.

SOURCE: SB 21-021 (2021 Session). ASLP-IC. (Accessed Aug. 2023).

Enacted Interstate Licensed Professional Counselor Compact.

SOURCE: SB 22-077 (2022 Session). Counseling Compact. (Accessed Aug. 2023).

* See Compact websites for implementation and license issuing status and other related requirements.

Last updated 08/08/2023

Miscellaneous

Colorado law includes in its definition of “health care services” the rendering of the services through the use of telehealth, as defined in section 10-16-123 (4)(e).

SOURCE: CO Revised Statutes 10-16-102(33). (Accessed Aug. 2023).

Telehealth, telerehabilitation, and teletherapy are included within the practice of occupational therapy.

SOURCE: CO Revised Statutes 12-270-104. (Accessed Aug. 2023).

Specifies certain CPT codes that may be provided via telemedicine for Workers’ Compensation. It also sets reimbursement requirements for distant site and originating site providers.

SOURCE: 7 CCR 1101-3, Rule 18-4(I)(1-4) (Accessed Aug. 2023).

Behavioral Health Entities may use telehealth methods for the provision of services except for services that specifically require in-person contact.

If the BHE uses telehealth methods, it shall develop and implement policies and procedures regarding telehealth services. Such policies may be for the BHE, a physical location, or an endorsement, as appropriate, and shall include, at a minimum, a requirement that telehealth services be provided only through synchronous, interactive audio-visual methods, not including voice-only or text-only methods such as telephone, text message, or email.

Services provided via telehealth methods shall be documented in the client record, consistent with documentation as required for in-person services.

SOURCE: 6 CCR 1011-1, Chap. 3, 2.8.3 (Accessed Aug. 2023).

Statewide Electronic Registry of Advance Directives: Considerations for Telehealth

An individual or their authorized surrogate may sign an electronic affidavit in the presence of a Qualified Provider either in person or via telehealth (over video or telephone).
In situations in which an individual is not able to access the Electronic Affidavit in the Registry, the individual may either electronically or physically sign the affidavit in the presence of a Qualified Provider either in person or via telehealth (over video or telephone)
A signed affidavit must be submitted to the Qualified Provider by the individual either via mail, email, or fax to the Qualified Provider in a timely manner.
It is the responsibility of the individual to ensure their documents have been received and appropriately uploaded to the Registry.
If the visit occurs via telehealth, a Qualified Provider must follow their existing organizational telehealth policies to ensure identity verification and adequate privacy and confidentiality.

If an Electronic Affidavit is not required an individual or their authorized surrogate may elect to meet with a Qualified Provider to discuss Advance Care Planning in person or via telehealth, but it is not required.

If an individual or their authorized surrogate elects not to discuss their documents at a visit with a Qualified Provider, the Provider is responsible for uploading their documents to the registry in a timely manner. However, the individual or their authorized surrogate are responsible for ensuring that the provider has received their documents (electronically or in hard copy) and that their Provider has uploaded their documents to the Registry.

SOURCE: 5 CCR 1006-3, VIII. (Accessed Aug. 2023).

The practice of acupuncture includes the provision of acupuncture services through telehealth.

SOURCE: CO Revised Statutes 12-200-103. (Accessed Aug. 2023).

Legislation authorizes the Director to adopt rules regarding the ability of an acupuncture aide to perform specified tasks under the supervision of an acupuncturist, including rules establishing the appropriate use of telehealth to provide acupuncture services.

SOURCE: CO Revised Statutes 12-200-114. (Accessed Aug. 2023).

The scope of practice for a hearing aid provider includes prescribing, selecting and fitting appropriate hearing instruments and assistive devices, including appropriate technology, electroacoustic targets, programming parameters, and special applications, as indicated, whether in person or through the use of telehealth.

SOURCE: CO Revised Statutes 12-230-104(1)(e) (Accessed Aug. 2023).

The Behavioral Health Administration (BHA) shall In collaboration with the department of regulatory agencies, establish workforce standards that strengthen the behavioral health-care provider workforce, including telehealth providers, and increase opportunities for peer support professionals and behavioral health aides. The BHA shall also other departments to address licensing and credentialing portability issues that affect the ability of children, youth, and adults to access behavioral health-care services.

The Division of Professions and Occupations shall, on or before September 1, 2022 make recommendations to expand the portability of existing credentialing requirements through statutory changes, including the adoption of interstate compacts in order to facilitate for mental health and behavioral health-care providers the use of telehealth to practice in multiple jurisdictions.

SOURCE: CO Revised Statutes 27-60-303(1). (Accessed Aug. 2023).

A peer support professional may provide services on behalf of a Recovery Support Services Organization in a variety of clinical and nonclinical settings, that may include but are not limited to Services delivered via telehealth

SOURCE: 2 CO Code of Regulations 502-1 21.600.41(B)(4). (Accessed Aug. 2023).

Last updated 08/08/2023

Online Prescribing

Colorado Medical Board

Provider-patient relationships may be established using telehealth technologies so long as the relationship is established in conformance with generally accepted standards of practice. Where an existing provider-patient relationship is not present, a provider must take appropriate steps to establish a provider-patient relationship consistent with the guidelines identified in Board Policy 40-3 and listed below.

The Board defines “Provider” to include licensees regulated by the Board and the “Provider-Patient Relationship” as the mutual understanding, between a provider and patient, of the shared responsibility for the patient’s healthcare. This relationship is established when:

The provider agrees to undertake diagnosis and treatment of the patient, and the patient, or a medical proxy for the patient, agrees to be treated- whether or not there has been an in-person encounter between the
patient and the provider; and,
The provider:
- Verifies and authenticates the patient’s identity and location;
- Discloses his or her identity and applicable credential(s) to the patient; and
- Obtains appropriate informed consent after any relevant disclosures regarding the delivery models and treatment methods or limitations, including any special informed consents regarding the use of telehealth technologies.

A “Provider-Patient Relationship” has not been established when either the identity of the provider
is unknown to the patient, or the identity of the patient is not known to the provider.

SOURCE: The Colorado Medical Board Policies, 40-03, page 57. Colorado Medical Board Policy Statement Regarding the Provider/Patient Relationship. 8/20/15. (Accessed Aug. 2023).

It is the position of the Colorado Medical Board that it is unprofessional conduct for a provider to provide treatment and consultation recommendations, including issuing a prescription, via any means, unless a provider-patient relationship, as defined in Board Policy 40-3, has been established.

Prescribing for a patient whom the provider has not personally examined may or may not be suitable under certain circumstances. Such circumstances may include, but are not limited to, admission orders for a newly hospitalized patient, prescribing for a patient of another provider for whom the provider is taking call, or continuing medication on a short-term basis for a new patient prior to the patient’s first appointment. Providers of medical care through telehealth technologies should adhere to the guidelines articulated in Board Policy 40-27.

SOURCE: The Colorado Medical Board Policies, 40-09, page 63. Guidelines for Prescribing for Unknown Patients. 8/20/15. (Accessed Aug. 2023).

An appropriate medical evaluation and review of relevant clinical history, commensurate with the presentation of the patient to establish diagnoses and identify underlying conditions and/or contra-indications to the treatment recommended/provided, should be performed prior to providing treatment, including issuing prescriptions, electronically or otherwise. Treatment and consultation recommendations made in an online setting, including issuing a prescription via electronic means, will be held to the same standards of appropriate practice as those in traditional (encounter in person) settings. Treatment, including issuing a prescription based solely on an online
questionnaire, does not constitute an acceptable standard of care.

Prescribing medications, in-person or via telehealth technologies, is at the professional discretion of the provider. The indication, appropriateness, and safety considerations for each telehealth visit prescription must be evaluated by the provider in accordance with current standards of practice and consequently carry the same professional accountability as prescriptions delivered during an encounter in person. However, where such measures are upheld, and the appropriate clinical consideration is carried out and documented, providers may exercise their judgment and prescribe medications as part of telehealth encounters.

The recommendation of medical marijuana via telehealth technologies is prohibited.

SOURCE: The Colorado Medical Board Policies, 40-27, page 101-102. Guidelines for the Appropriate Use of Telehealth Technologies in the Practice of Medicine. 8/19/21. (Accessed Aug. 2023).

A pharmacist shall not dispense a prescription drug if the pharmacist knows or should know that the order for such drug was issued without a valid preexisting patient-practitioner relationship. Such relationship need not involve an in-person encounter between the patient and practitioner if otherwise permissible under Colorado law. A pharmacist may, in good faith, dispense an opiate antagonist pursuant to an order that was issued without a valid preexisting patient-practitioner relationship under the following conditions:

1. The opiate antagonist is not a controlled substance; and
2. The opiate antagonist is approved by the Federal Food and Drug Administration for the treatment of a drug overdose.

SOURCE: 3 CO Code of Regulation 719-1. 3.00.21, p. 9. (Accessed Aug. 2023).

Workers’ Compensation

The physician-patient relationship/psychologist-patient relationship can be established through live audio/video services.

SOURCE: 7 CO Regs. Rule 1101-3, 18-5(I)(3), p. 30. (Accessed Aug. 2023).

“Bona fide physician-patient relationship”, for purposes of the medical marijuana program, means:

A physician and a patient have a treatment or counseling relationship, in the course of which the physician has completed a full assessment of the patient’s medical history, including reviewing a previous diagnosis for a debilitating or disabling medical condition, and current medical condition, including an appropriate personal physical examination. “Appropriate personal physical examination” may not be performed by remote means, including telemedicine.

SOURCE: 5 CO Regs. Rule 1006-2. (Accessed Aug. 2023).

Last updated 08/08/2023

Professional Boards Standards

Colorado Medical Board

Evaluation and Treatment of the Patient: An appropriate medical evaluation and review of relevant clinical history, commensurate with the presentation of the patient to establish diagnoses and identify underlying conditions and/or contra-indications to the treatment recommended/provided, should be performed prior to providing treatment, including issuing prescriptions, electronically or otherwise. Treatment and consultation recommendations made in an online setting, including issuing a prescription via electronic means, will be held to the same standards of appropriate practice as those in traditional (encounter in person) settings. Treatment, including issuing a prescription based solely on an online questionnaire, does not constitute an acceptable standard of care.

Continuity of Care: Physicians should adhere to generally accepted standards of medical practice as it relates to continuity and coordination of care.

Referrals for Emergency Services: An emergency plan should be provided by the provider to the patient when the care provided using telehealth technologies indicates that a referral to an acute care facility or Emergency Department for treatment is necessary for the safety of the patient.

Medical Records: The medical record should include, if applicable, copies of all patient-related electronic communications, including patient-provider communication, prescriptions, laboratory and test results, evaluations and consultations, records of past care, and instructions obtained or produced in connection with the utilization of telehealth technologies. Informed consents obtained in connection with an encounter involving telehealth technologies should also be filed in the medical record. The patient record established during the use of telehealth technologies must be accessible and documented for both the provider and the patient, consistent with all established laws and regulations governing patient healthcare records.

Privacy and Security of Patient Records & Exchange of Information: Providers should meet or exceed applicable federal and state legal requirements of medical/health information privacy, including compliance with the Health Insurance Portability and Accountability Act (HIPAA) and state privacy, confidentiality, security, and medical record retention rules. Written policies and procedures should be maintained at the same standard as traditional in person encounters for documentation, maintenance, and transmission of the records of the encounter using telehealth technologies.

Parity of Professional and Ethical Standards: A provider’s professional discretion as to the diagnoses, scope of care, or treatment should not be limited or influenced by non-clinical considerations of telehealth technologies, and provider remuneration or treatment recommendations should not be materially based on the delivery of patient-desired outcomes (i.e. a prescription or referral) or the utilization of telehealth technologies.

Exemptions from Policy 40-27 Guidelines for the Appropriate Use of Telehealth Technologies in the Practice of Medicine: The Colorado Medical Board recognizes the challenges during a public health emergency. The Food and Drug Administration (“FDA”) guidelines for testing in times of a public health emergency shall guide Colorado policy for the purposes of Policy 40-27: Guidelines for the Appropriate Use of Telehealth Technologies in the Practice of Medicine.

SOURCE: The Colorado Medical Board Policies, 40-27, page 101-103. Guidelines for the Appropriate Use of Telehealth Technologies in the Practice of Medicine. 8/19/21. (Accessed Aug. 2023).

Colorado Mental Health Boards Teletherapy Policy

Evaluation and Treatment of the Patient: An appropriate mental health evaluation and review of relevant clinical history, commensurate with the presentation of the patient to establish diagnoses and identify underlying conditions, should be performed prior to providing treatment. Treatment and consultation recommendations made in an online setting will be held to the same standards of appropriate practice as those in traditional (encounter in person) settings.

Mandatory Disclosure Statement: Appropriate mandatory disclosure statement should be obtained for a teletherapy encounter including those elements required by law and generally accepted standards of practice.

Continuity of Care: Licensees, certificate holders, and registrants should adhere to generally accepted standards of mental health practice as it relates to continuity and coordination of care.

Referrals for Emergency Services: An emergency plan should be provided by the provider to the patient when the care provided using teletherapy technologies indicates that a referral to an Emergency Department for treatment is necessary for the safety of the patient.

Mental Health Records: The mental health record should include, if applicable, copies of all patient-related electronic communications, including patient-provider communication, evaluations and consultations, records of past care, and instructions obtained or produced in connection with the utilization of teletherapy technologies. Mandatory disclosure statements obtained in connection with an encounter involving teletherapy technologies should also be filed in the mental health record. The patient record established during the use of teletherapy technologies must be accessible and documented for both the provider and the patient, consistent with all established laws and regulations governing patient healthcare records.

Privacy and Security of Patient Records & Exchange of Information: Providers should meet or exceed applicable federal and state legal requirements of mental health information privacy, including compliance with the Health Insurance Portability and Accountability Act (HIPAA) and state privacy, confidentiality, security, and medical record retention rules. Written policies and procedures should be maintained at the same standard as traditional in-person encounters for documentation, maintenance, and transmission of the records of the encounter using teletherapy technologies.

Disclosures and Functionality for Providing Online Services: Disclosures and advertising should be made in accordance with state and federal law. Parity of Professional and Ethical Standards. There should be parity of ethical and professional standards applied to all aspects of a provider’s practice. A provider’s professional discretion as to the diagnoses, scope of care, or treatment should not be limited or influenced by non-clinical considerations of teletherapy technologies, and provider remuneration or treatment recommendations should not be materially based on the delivery of patient-desired outcomes or the utilization of teletherapy technologies.

Policy

When listed, certified, registered, or licensed and treating clients within the State of Colorado, it is at the discretion of the licensee, certificate holder, or registrant as to the type of modality of treatment format that is appropriate for the client. Regardless of the modality chosen, the licensee, certificate holder, or registrant must comply with all provisions as outlined in the Mental Health Practice Act, Title 12 Article 43.

Once a licensee, certificate holder, or registrant chooses to provide psychotherapy via electronic means, the licensee, certificate holder, or registrant is expected to carefully identify and address issues that involve:

The agreed upon therapeutic means of communication between the client and the licensee, certificate, or registrant. (i.e. if/when will face-to-face contact be appropriate, what method(s) of electronic communication will be utilized, what is
the structure of the contractual relationship);
Implementing consent form(s) and proper disclosure(s) including, but not limited to the client’s knowledge regarding security issues, confidentiality, structure, etc.;
Ensuring that the therapeutic means of communication includes confidentiality and computer/cyber security;
Determining the basis and ability for the licensee, certificate holder, or registrant to support the rationale for the decision to choose a particular therapeutic method;
Ensuring that the licensee, certificate holder, or registrant is practicing within his/her scope of practice;
Ensuring that the therapeutic means of communication that is chosen does not cause any potential harm to the client.

The licensee, certificate holder, or registrant may encounter specific challenges while providing psychotherapy through electronic means. The licensee, certificate holder, or registrant must realize that these challenges may include, but are not limited to:

Verifying the identity of the client and determining if they are a minor;
Providing the client with procedures for alternative modes of communication when there is possible technology failure;
Assessing how to cope with potential misunderstandings when the visual cues that would normally occur during face-to-face visits do not exist;
Assessing how to address crisis intervention when necessary;
Ensuring that clients are knowledgeable with regard to encryption methods, firewall, and backup systems to help secure communication and educate clients on the risk of unsecured communications;
Establishing a means to retain and preserve data;
Upon request, have the ability to capture and provide client treatment notes, summaries or other information that is received via the electronic technology;
Disclosing that health insurance coverage may not exist for psychotherapy service that is provided through technological means.

Disclaimer: This policy applies only to mental health professionals who are certified, registered, or licensed, and treating clients within the State of Colorado.

SOURCE: State Board of Psychologist Examiners Policies, 30-1, page 10-12. Teletherapy Policy – Guidance regarding Psychotherapy through Electronic Means. 2/2/18. (Accessed Aug. 2023).

Federally Qualified Health Center (FQHC)

Last updated 08/08/2023

Definition of Visit

For Health First Colorado a billable encounter at an FQHC/RHC is an in person or telemedicine face to face visit with a Health First Colorado member. Telemedicine services are limited to the procedure codes identified on the Telemedicine Provider Information web page and Telemedicine Manual under General Billing Information. When a Federally Qualified Health Center or a Rural Health Clinic provides care through telemedicine, the claim must include the modifier GT on line(s) identifying the service(s).

SOURCE: CO FQHC & RHC Billing Manual 8/22. (Accessed Aug. 2023).

SOURCE: Colorado Adopted Rule 8.700.1. (Accessed Aug. 2023).

Last updated 08/08/2023

Eligible Distant Site

SOURCE: CO FQHC & RHC Billing Manual 8/22. (Accessed Aug. 2023).

All distant site rendering providers bill the appropriate procedure code using Place of Service code 02 or 10 and the appropriate modifiers FQ or FR on the CMS 1500 paper claim form or as an 837P transaction.

Place of Services codes 02 and 10 can be used during telehealth encounters:

POS 02: Telehealth provided other than in the patient’s home. The location where health services and health related services are provided or received, through telecommunication technology. Patient is not located in their home when receiving health services or health related services through telecommunication technology.
POS 10: Telehealth Provided in Patient’s Home. The location where health services and health related services are provided or received through telecommunication technology. Patient is located in their home (which is a location other than a hospital or other facility where the patient receives care in a private residence) when receiving health services or health related services through telecommunication technology.

Additionally, modifiers FQ, FR, 93, and 95 can be added to POS 2 and 10:

FQ: The service was furnished using audio-only communication technology.
FR: The supervising practitioner was present through two-way, audio/video communication technology.
93: Synchronous Telemedicine Service Rendered Via Telephone or Other Real-Time Interactive Audio-Only Telecommunications System
95: Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System

FQHC/RHCs may bill using modifier GT. When used by an FQHC or RHC, the modifier GT identifies the services as being delivered through telemedicine modality. There is no enhanced payment to FQHCs and RHCs when using the modifier GT.

SOURCE: CO Department of Health Care Policy and Financing. “Telemedicine Billing Manual” 7/23. (Accessed Aug. 2023).

Last updated 08/08/2023

Eligible Originating Site

FQHCs providers can serve as an originating site allowing a member to connect with a distant provider that is not affiliated with the originating site. The service must be submitted on a professional service claim form (the 1500). See the Telemedicine Billing Manual for the coverage of the originating site procedure code.

SOURCE: CO FQHC & RHC Billing Manual 8/22. (Accessed Aug. 2023).

FQHC are eligible for the originating site facility fee and may bill procedure code Q3014 (telemedicine originating site facility fee).

SOURCE: CO Department of Health Care Policy and Financing. “Telemedicine Billing Manual” 7/23. (Accessed Aug. 2023).

Last updated 08/08/2023

Facility Fee

FQHCs are eligible for the originating site facility fee and may bill procedure code Q3014 (telemedicine originating site facility fee).

SOURCE: CO Department of Health Care Policy and Financing. “Telemedicine Billing Manual” 7/23. (Accessed Aug. 2023).

See: CO Medicaid Live Video Facility/Transmission Fee

Last updated 08/08/2023

Home Eligible

Generally, the manual states that services can be provided via telemedicine between a member and a distant provider when a member is located in their home or other location of their choice. General modifier instructions for all distant site providers, which includes FQHCs/RHCs, include POS 10 references.

SOURCE: CO Department of Health Care Policy and Financing. “Telemedicine Billing Manual” 7/23. (Accessed Aug. 2023)

Last updated 08/08/2023

Modalities Allowed

Live Video

Telemedicine may be provided through interactive audio, interactive video, or interactive data communication, including but not limited to telephone, relay calls, interactive audiovisual modalities, and live chat, as long as the technologies are compliant with the federal “Health Insurance Portability and Accountability Act of 1996”, Pub.L. 104-191, as amended. The health-care or mental health-care services are subject to reimbursement policies developed pursuant to the medical assistance program. A telemedicine service meets the definition of a face-to-face encounter for a rural health clinic, Indian health service, or federally qualified health center.

See: CO Medicaid Live Video

SOURCE: CO Dept. of Health Care Policy and Financing. Telemedicine Billing Manual. (7/23). (Accessed Aug. 2023).

Store and Forward

The member typically must be present during any Telemedicine visit, limiting ability to use store-and-forward modalities.

See: CO Medicaid Store-and-Forward

Health First Colorado only allows reimbursement for a visit, which is a face-to-face encounter between a Health First Colorado member and a provider listed at 10 CCR 2505-10 sections 8.700.6 and 8.700.1. A direct visualization by a physician without the member present is not billable as an encounter.

SOURCE: CO FQHC & RHC Billing Manual 10/22. (Accessed Aug. 2023).

Remote Patient Monitoring

Health First Colorado only allows RPM coverage in limited circumstances.

See: CO Medicaid RPM

For FQHCs/RHCs, a direct visualization by a physician without the member present is not billable as an encounter. In addition, for the technical component of an imaging service, when free standing FQHCs own the equipment, the costs are accounted for in the Prospective Payment System (PPS) rate and the technical component is not billable.

SOURCE: CO FQHC & RHC Billing Manual 10/22. (Accessed Aug. 2023).

Audio-Only

SOURCE: CO Dept. of Health Care Policy and Financing. Telemedicine Billing Manual. (7/23). (Accessed Aug. 2023).

See: CO Medicaid Email, Phone and Fax

Last updated 08/08/2023

Patient-Provider Relationship

No Reference Found.

For general information about forming a patient-provider relationship see: Colorado Professional Requirements Online Prescribing

Last updated 08/08/2023

PPS Rate

SOURCE: CO Statute, Sec. 25.5-5-320. (Accessed Aug. 2023).

Generally, FQHCs get PPS from CO Medicaid: The Department will perform an annual reconciliation to ensure each FQHC has been paid at least their per visit Prospective Payment System (PPS) rate.

SOURCE: Colorado Adopted Rule 8.700.6.D. (Accessed Aug. 2023).

Last updated 08/08/2023

Same Day Encounters

CPT and HCPCS codes cannot be repeated for the same date of service.

SOURCE: CO FQHC & RHC Billing Manual 8/22. (Accessed Aug. 2023).

Colorado

MEDICAID REIMBURSEMENT

PRIVATE PAYER LAW

PROFESSIONAL REQUIREMENTS

FQHCs

STATE RESOURCES

COVID-19

Audio Only Delivery

Cross State Licensing

Easing Consent Requirements

Easing Prescribing Requirements

Miscellaneous

Originating Site

Private Payer

Provider Type

Service Expansion

Private Payer

Definitions

Parity

SERVICE PARITY

PAYMENT PARITY

Requirements

Medicaid

Consent Requirements

Definitions

Email, Phone & Fax

Live Video

POLICY

ELIGIBLE SERVICES/SPECIALTIES

ELIGIBLE PROVIDERS

ELIGIBLE SITES

GEOGRAPHIC LIMITS

FACILITY/TRANSMISSION FEE

Miscellaneous

Out of State Providers

Overview

Remote Patient Monitoring

POLICY

CONDITIONS

PROVIDER LIMITATIONS

OTHER RESTRICTIONS

Store and Forward

POLICY

ELIGIBLE SERVICES/SPECIALTIES

GEOGRAPHIC LIMITS

FACILITY/TRANSMISSION FEE

Professional Requirements

Consent Requirements

Cross State Licensing

Definitions

Licensure Compacts

Miscellaneous

Online Prescribing

Professional Boards Standards

Federally Qualified Health Center (FQHC)

Definition of Visit

Eligible Distant Site

Eligible Originating Site

Facility Fee

Home Eligible

Modalities Allowed

Live Video

Store and Forward

Remote Patient Monitoring

Audio-Only

Patient-Provider Relationship

PPS Rate

Same Day Encounters