Co-Pay Information for Providers
| Members Exempt from Co-pay | Services Exempt from Co-pay |
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| Please refer to the General Provider Information Manual for additional information. | |
Co-Pay Amounts
| Service type | Co-pay |
| Inpatient hospital services | $10 per day; never more than half of the cost Health First Colorado pays for the first day of care in the hospital |
| Outpatient surgery at an Ambulatory Surgery Center | $0 each visit |
| Outpatient hospital non-emergent emergency room visit | $6 each visit |
| Primary Care Physician and specialist services | $2 each visit |
| Clinic services | $2 each day of service |
| Laboratory services | $1 each day of service |
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Radiology services *Dental X-rays do not have co-pay |
$1 each day of service |
| Prescription drugs or services (each prescription or refill) | $3 generic, $3 name-brand; same co-pay for a 3-month supply by mail |
Co-pay Facts
- Auto-deducted during claims processing
- Do not deduct from charges billed on claim
- A provider may not deny services to an individual when such members are unable to immediately pay the co-pay amount. However, the member remains liable for the co-pay at a later date. (8.754.6.B rule in 10 CCR 2505 volume 8.700)
- Youth from birth to 18 years old are considered children
- Services that do not require co-pay:
- Dental
- Home Health
- HCBS waiver services
- Transportation
- Emergency Services
- Family Planning Services
- Behavioral Health Services (mental health and substance use disorder)
- Do not collect a co-pay from members who have already reached their monthly co-pay limit. If a co-pay is collected on the date of service, but the member has met their monthly co-pay limit when the claim is submitted, the co-pay should be refunded to the member. If a member cannot be reached by mail, a credit may be kept on file for the member’s future use. More information on member co-pays is found on the Health First Colorado Co-Pay page.
Where to Find Co-Pay Amounts on the RA
