COLORADO TELEMEDICINE LAW
Colorado has made great strides in improving the availability and access to telemedicine in the centennial state. Colorado currently has a partial telemedicine parity law, which mandates coverage for telemedicine in rural areas. Recently passed legislation (going into effect in 2017) will remove that location restriction and mandate telemedicine coverage for the whole state, not just rural parts.
Ready to find out more about Colorado’s telemedicine policies? Check out our state guide below!
Parity Law
When a state passes a telemedicine parity law, it means private payers are required to reimburse live telemedicine the same way as in-person visits. Colorado currently had a partial parity law that mandates telemedicine reimbursement, but only for rural areas of the state. The good news is, Colorado just voted in 2015 to remove those geographical barriers. Those changes will take full effect in January 2017.
Type of Telemedicine Covered
Colorado Medicaid covers reimbursements for live video telemedicine for both medical and mental health services at the same rate as in-person services. Remote Patient Monitoring is reimbursed, but only for chronic disease management as a flat fee.
Colorado Medicaid does not reimburse for store and forward technology telehealth services.
Covered Health Services
Colorado Medicaid reimburses for live video telemedicine for both medical and mental/behavioral health services, as well as speech therapy services. For more detail, check out our billing codes section.
Billing Codes
Need a list of the eligible Colorado Medicaid codes for telemedicine? We’ve got you covered:
Evaluation & Management
99201 Office or other outpatient visit, new patient, 10 minutes
99202 Office or other outpatient visit, new patient, 20 minutes
99203 Office or other outpatient visit, new patient, 30 minutes
99204 Office or other outpatient visit, new patient, 45 minutes
99205 Office or other outpatient visit, new patient, 60 minutes
99211 Office or other outpatient visit, established patient, 5 minutes
99212 Office or other outpatient visit, established patient, 10 minutes
99213 Office or other outpatient visit, established patient, 15 minutes
99214 Office or other outpatient visit, established patient, 25 minutes
99215 Office or other outpatient visit, established patient, 40 minutes
Outpatient Mental Health
90791 Diagnostic evaluation. If interactive complexity then report with add on code 90785
90832 Psychotherapy, 30 min (actual time can be 16-37 min. If interactive complexity then report with add on code 90785
90833 Add on Psychotherapy 30 min (actual time can be 16-37 min) Use in conjunction with appropriate E/M codeIf interactive complexity then report with add on code 90785
90834 Psychotherapy 45 min (actual time can be 38-52 min)If interactive complexity then report with add on code 90785
90836 Add on Psychotherapy 45 min (actual time can be 38-52 min) Use in conjunction with appropriate E/M code. If interactive complexity then report with add on code 90785
90837 Psychotherapy 60 min (actual time can be 53+) Medicare crossover only
90838 Add on Psychotherapy 60 min (actual time can be 53+ Use in conjunction with appropriate E/M code). Medicare crossover only
90863 Add on Pharmacologic management code can be added to primary psychotherapy code
90846 Family therapy – patient not present
90847 Family therapy – patient present
Don’t forget your GT modifier! Providers should also use the GT modifier with the relevant code to note telemedicine.
Want more details? Check out the Colorado Medicaid Handbook.
Eligible Healthcare Providers
Here’s the list of healthcare providers who are eligible to get reimbursed for telemedicine in Colorado:
Physician
Clinic
Osteopath
FQHC
Psychologist
MA Psychologist
Physician Assistant
Nurse Practitioner
Rural Health Clinic
Online Prescriptions
Colorado does not allow physicians to prescribe patients controlled substances and dangerous drugs based only on an internet-based questionnaire, online consult, or a telephone consultation.
Informed Patient Consent
Colorado requires providers to get all first-time patients’ written consent before a telemedicine visit. We recommend this as a telemedicine best practice anyway!
Interstate Telemedicine Licensing
Colorado doesn’t have any Interstate medical licensing compacts in place for telemedicine yet, but that could change soon!
Restrictions on Locations
Colorado has enacted new laws removing the restriction to rural areas. The new laws go into effect starting January 2017.
Documenting Barriers to In-Person Care
Colorado Medicaid waives the requirement for an initial face-to-face meeting with a new patient when the following written statements are signed by patient or patient’s legal representative:
The client retains the option to refuse the delivery of healthcare services via telemedicine at any time without affecting the client’s right to future care or treatment and without risking the loss or withdrawal of any program benefits to which the client would otherwise be entitled.
All applicable confidentiality protections shall apply to the services.
The client 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.
Other Reimbursable Fees
In addition to the billing for the actual medical service, if the patient is doing the visit from a hosting (originating site), that site can charge a facility fee. Lookup HCPCS code Q3014 for details.
Reimbursement Rates
Good news! Colorado Medicaid reimburses telemedicine services with the same physician fee schedule amount for that medical service. Rates for a telemedicine services are the same as the comparable in-person medical service.
Helpful Resources
Center for Connected Health Policy – Colorado State Page
Colorado Medicaid Telemedicine Handbook
The American Telemedicine Association State Policy Matrix
The Southwest Telehealth Resource Center