Statutes, codes, and regulations
Colorado Administrative Code
Department 1100 - Department of Labor and EmploymentDivision 1101 - Division of Workers' Compensation
Rule 7 CCR 1101-3 Rule 18 - Rule 18, MEDICAL FEE SCHEDULE (Rule 18 exhibits published separately)
Section 7 CCR 1101-3-18-3 - GENERAL POLICIES

7 Colo. Code Regs. § 1101-3-18-3

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Current through Register Vol. 47, No. 24, December 25, 2024
Section 7 CCR 1101-3-18-3 - GENERAL POLICIES
(A) BILLING CODES AND FEE SCHEDULE
(1) The Division establishes the Medical Fee Schedule based on RBRVS, as modified by Rule 18 and its Exhibits.
(2) The Division incorporates CPT®, HCPCS, CDT® and National Drug Code (NDC) codes and values, unless otherwise specified in Rule 18. Providers may use CPT® Category III codes listed in the RBRVS with Payer agreement. Payment for the Category III codes shall comply with Rule 16 policy for unpriced codes.
(3) Division-created codes and values (DoWC ZXXXX) supersede CPT®, HCPCS, CDT®, and NDC codes and values. The CPT® mid-point rule for attaining a unit of time applies to these codes, unless otherwise specified in this Rule.
(4) Codes listed with values of "BR" (by report), not listed, or listed with a zero value and not included by Medicare in another procedure(s), require prior authorization.
(B) PLACE OF SERVICE CODES

The table below lists the place of service codes corresponding to the RBRVS facility RVUs. All other maximum fee calculations shall use the non-facility RVUs listed in the RBRVS.

Place of Service Code

Place of Service Code Description

21

Inpatient Hospital

22

On Campus - Outpatient Hospital

23

Emergency Room-Hospital

24

Ambulatory Surgery Center (ASC)

26

Military Treatment Facility

31

Skilled Nursing Facility

34

Hospice

41

Ambulance - Land

42

Ambulance - Air or Water

51

Inpatient Psychiatric Hospital

52

Psychiatric Facility-Partial Hospitalization

53

Community Mental Health Center

56

Psychiatric Residential Treatment Center

61

Comprehensive Inpatient Rehabilitation Facility

(C) CORRECT REPORTING AND PAYMENT POLICIES
(1) Providers shall report codes and number of units based on all applicable code descriptions and this Rule. In addition, Providers shall document all services/procedures in the medical record.
(2) Providers shall report the most comprehensive code that represents the entire service.
(3) Providers shall report only the primary services and not the services that are integral to the primary services.
(4) Providers shall document the time spent performing all time-based services or procedures in accordance with applicable code descriptions.
(5) Providers shall apply modifiers to clarify services rendered and/or adjust the maximum allowances as indicated in this Rule. When correcting a modifier, Payers shall comply with Rule 16.

7 CCR 1101-3-18-3

37 CR 13, July 10, 2014, effective 7/30/2014
38 CR 01, January 10, 2015, effective 2/1/2015
38 CR 05, March 10, 2015, effective 4/1/2015
38 CR 11, June 10, 2015, effective 7/1/2015
38 CR 17, September 10, 2015, effective 1/1/2016
39 CR 04, February 25, 2016, effective 3/16/2016
39 CR 13, July 10, 2016, effective 7/30/2016
39 CR 16, August 25, 2016, effective 9/14/2016
39 CR 19, October 10, 2016, effective 1/1/2017
40 CR 03, February 10, 2017, effective 3/2/2017
40 CR 11, June 10, 2017, effective 7/1/2017
40 CR 21, November 10, 2017, effective 11/30/2017
40 CR 18, September 25, 2017, effective 1/1/2018
40 CR 20, October 25, 2017, effective 1/1/2018
41 CR 11, June 10, 2018, effective 7/1/2018
41 CR 19, October 10, 2018, effective 1/1/2019
41 CR 20, October 25, 2018, effective 1/1/2019
41 CR 23, December 10, 2018, effective 1/1/2019
42 CR 01, January 10, 2019, effective 1/30/2019
42 CR 11, June 10, 2019, effective 6/30/2019
42 CR 12, June 25, 2019, effective 7/15/2019
42 CR 21, November 10, 2019, effective 11/30/2019
42 CR 20, October 25, 2019, effective 1/1/2020
42 CR 23, December 10, 2019, effective 1/1/2020
43 CR 03, February 10, 2020, effective 1/1/2020
43 CR 07, April 10, 2020, effective 4/30/2020
43 CR 11, June 10, 2020, effective 7/1/2020
43 CR 16, August 25, 2020, effective 10/14/2020
43 CR 21, November 10, 2020, effective 1/1/2021
44 CR 07, April 10, 2021, effective 4/30/2021
44 CR 08, April 25, 2021, effective 7/1/2021
44 CR 13, July 10, 2021, effective 7/30/2021
44 CR 20, October 25, 2021, effective 1/1/2022
44 CR 23, December 10, 2021, effective 1/1/2022
44 CR 23, December 10, 2021, effective 1/10/2022
45 CR 01, January 10, 2022, effective 1/30/2022
45 CR 11, June 10, 2022, effective 7/1/2022
45 CR 13, July 10, 2022, effective 8/10/2022
45 CR 21, November 10, 2022, effective 12/6/2022
46 CR 01, January 10, 2023, effective 12/6/2022
45 CR 19, October 10, 2022, effective 1/1/2023
46 CR 02, January 25, 2022, effective 1/1/2023
46 CR 02, January 25, 2023, effective 3/2/2023
46 CR 05, March 10, 2023, effective 3/30/2023
46 CR 19, October 10, 2023, effective 1/1/2024
47 CR 21, November 10, 2024, effective 1/1/2025