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Health First Colorado covers audiology services and devices. This includes hearing exams and hearing aids for specific age groups. Services take place in the office, hospital, home, and other settings.
All enrolled members are eligible to receive these services, however specific limitations apply to certain procedures and devices.
Reference the billing and policy manual for complete details.
A variety of CPT billing codes are available for billing. These include but are not limited to:
As a Health First Colorado (Colorado's Medicaid Program) provider, you have the opportunity to improve the health and well-being of more than a million Coloradans. Health First Colorado is more than health insurance – it is a vital public service, helping almost one in five Colorado citizens stay healthy or move towards better health.
The enrollment process is online and begins on the Become a Provider page.
Enrollment in Managed Care networks is only required if the member being treated is in the Denver Health or Rocky Mountain Health Plan networks.
Audiology services are reimbursed according to the current Health First Colorado Fee Schedule. Reimbursement rates will vary by CPT code reported. The fee schedule shows the maximum allowed reimbursement for each CPT code. Submitted claims will be reimbursed according to 'lesser-of' pricing logic. This means that the line item will reimburse either at submitted charges or the fee schedule rate, whichever is lesser.
Hospital providers of audiology services are subject to EAPG reimbursement methodology.
Providers must first enroll into the program to submit claims. Once they are enrolled, providers may submit claims directly by logging into the Provider Web Portal. Claims may be submitted by billing agencies on behalf of the provider.
Resources for enrollment and billing may be found at Provider Resources.
All Medicaid Rules, Regulations, and Statutes apply to the administration of the Colorado Medical Assistance Program at large, which providers are required to follow. The following are specifically called out as the ones governing the audiology benefit: