Colorado Billing Guide for Mental Health Therapists and Psychiatrists
Who pays, where to enroll and which rules change your claims in Colorado, for psychotherapists and psychiatric prescribers.
Last checked October 25, 2026. Reviewed against the official sources listed at the bottom of this page.
This Colorado billing guide covers Medicaid, Medicare, Blue Cross, other private payers and state law for therapists and psychiatrists, with sources and a last-checked date.
Colorado billing guide: how Colorado pays for outpatient care
Health First Colorado (Medicaid) is run by the Department of Health Care Policy and Financing (HCPF). Outpatient behavioral health is paid mainly through four Regional Accountable Entities (RAEs), so you contract with the RAE for the member's region. Gainwell Technologies is the fiscal agent for fee-for-service claims.
A provider without a RAE contract or a single case agreement cannot serve members assigned to that RAE. Health First Colorado will start a federal work requirement for applications and renewals on or after January 1, 2027.
Who to bill, at a glance
| Payer type | Who you bill | Where to enroll or check rules |
|---|---|---|
| Medicaid | HCPF; four RAEs run the behavioral health benefit; Gainwell for fee-for-service | HCPF ACC Phase III |
| Medicare Part B | Novitas Solutions, Jurisdiction H | CMS MAC page |
| Blue Cross Blue Shield | Anthem Blue Cross and Blue Shield (Colorado) | See the Blue Cross section below |
Colorado Medicaid: Health First Colorado
This Colorado billing guide starts with Medicaid, because it decides who pays and how you file.
Accountable Care Collaborative Phase III began July 1, 2025 with four RAEs, down from seven. RAEs administer the capitated behavioral health benefit and build the provider networks. HCPF says RAEs now prioritize providers that fill network gaps and show quality outcomes rather than contracting with any willing provider. Providers can contract with more than one RAE.
Two managed care organizations also operate: Elevate (Denver Health) Medicaid Choice, with behavioral health through Colorado Access, and Rocky Mountain Health Plans PRIME in certain western counties.
| Item | What to know |
|---|---|
| Agency | Colorado Department of Health Care Policy and Financing |
| Fiscal agent and portal | Gainwell Technologies, Health First Colorado provider web portal |
| Billing manual | State Behavioral Health Services (SBHS) Billing Manual |
| Fee-for-service filing window | 365 days from the date of service. Resubmit within 60 days with the prior ICN after 365 days. Revalidation is at least every five years. Source |
| Psychotherapy review | RAEs must review outpatient psychotherapy use beyond 24 sessions per state fiscal year. Source |
| Work requirement | Health First Colorado will implement the federal community engagement requirement for applications and renewals on or after January 1, 2027: 80 hours a month of work, program participation, volunteering or school, with renewals every 6 months. People with severe mental illness are treated as medically frail and exempt. Source |
Managed-care plans and carve-outs
| Plan or entity | Role in behavioral health |
|---|---|
| Rocky Mountain Health Plans (Region 1) | RAE for Region 1. Also runs behavioral health and substance use services for Region 2 since July 1, 2025. |
| Northeast Health Partners (Region 2) | RAE for Region 2. Behavioral health delegated to Rocky Mountain Health Plans from July 1, 2025. |
| Colorado Community Health Alliance (Region 3) | RAE for Region 3, which includes Boulder, Jefferson and El Paso counties. |
| Colorado Access (Region 4) | RAE for the Denver metro counties. Also manages behavioral health for Elevate Medicaid Choice. |
Confirm each RAE's timely filing limit and credentialing portal in its provider contract.
Medicare Part B in Colorado
For Medicare, this Colorado billing guide names your contractor and the current telehealth rules.
Medicare Part B pays for outpatient psychotherapy and psychiatric visits billed to the Medicare Administrative Contractor (MAC) for your state. CMS's July 14, 2026 fact sheet on the CY2027 Physician Fee Schedule proposed rule says the Consolidated Appropriations Act, 2026 extended telehealth payment authority through December 31, 2027, and proposes that in-person visit requirements for mental health visits not apply to services furnished through that date.
| Item | What to know |
|---|---|
| Contractor | Novitas Solutions, Inc. |
| Jurisdiction | Jurisdiction H: Arkansas, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma and Texas |
| Source | CMS.gov MAC page |
Blue Cross Blue Shield in Colorado
This part of the Colorado billing guide names the exact Blue Cross licensee, because Blue plans never share rules.
Blue Cross Blue Shield is a federation of independent companies, so one licensee's rules never apply to another. In Colorado that is Anthem Blue Cross and Blue Shield. Its legal entity is Rocky Mountain Hospital and Medical Service, Inc., and HMO products are underwritten by HMO Colorado, Inc., according to an Anthem Colorado provider notice. Its rules do not apply to Blue plans in other states.
| Licensee | Parent or affiliation | Where it applies | Provider resources |
|---|---|---|---|
| Anthem Blue Cross and Blue Shield (Colorado) | Rocky Mountain Hospital and Medical Service, Inc. | Colorado | Anthem Colorado provider news |
Other private payers and EAPs in Colorado
The Colorado billing guide also covers commercial plans and employee assistance programs.
These commercial payers and plan families most often matter for behavioral health billing in Colorado. Check each payer's current provider manual before you submit.
| Payer | Behavioral health note | Provider resources |
|---|---|---|
| Carelon Behavioral Health (Anthem) | Carelon manages behavioral health utilization for Anthem Colorado members. Claims and eligibility run through Availity Essentials, and behavioral health authorizations moved to Availity on August 1, 2025. | Official page |
| UnitedHealthcare Community Plan / Rocky Mountain Health Plans with Optum | This is a Medicaid plan, not commercial. Rocky Mountain Health Plans works with Optum Behavioral Health to manage the behavioral health network, and Optum credentials through Provider Express. | Official page |
Colorado billing guide: state law that changes billing
Use this section of the Colorado billing guide to separate state law from payer policy.
State law sets the floor for commercial plans in Colorado. Medicare and Medicaid rules are covered in their own sections above.
Mental health parity
HB19-1269 (2019) codifies federal parity requirements for private insurance and gives the Division of Insurance enforcement authority. Carriers submit annual quantitative and non-quantitative treatment limit data under Insurance Regulation 4-2-64. Division of Insurance parity report
Telehealth coverage and payment parity
C.R.S. 10-16-123 requires carriers to reimburse participating providers for telehealth on the same basis as the same service in person. Cost sharing may not exceed in-person. Carriers may not require a prior provider-patient relationship. Statute
Prompt payment
C.R.S. 10-16-106.5 requires carriers to pay, deny or settle a clean claim within 30 calendar days if electronic and 45 if paper. Late clean claims bear 10% annual interest. Statute
Practitioner scope: therapists and prescribers
In the HCPF manual, 90791 can be billed by LCSW, LPC, LMFT, licensed psychologists, LAC and APN, while 90792 is prescriber-only. The add-on 90833 lists only intern, APN, RxN, PA and MD/DO as eligible. Source
Not legal advice. Confirm statute details with counsel.
Colorado billing guide: codes and rates
This Colorado billing guide lists only codes and rates confirmed on official pages.
These are the Colorado-specific codes, modifiers and rate items confirmed on official pages. Medicare's own CY2027 conversion factor proposal is listed under What changed.
| Code or item | What to know |
|---|---|
| 90832, 90834 and 90837 time ranges | SBHS manual: 90832 is 16 to 37 minutes, 90834 is 38 to 52 minutes and 90837 is 53 to 74 minutes. Two units of 90834 may be billed as an extended encounter for a session over 74 minutes. Source |
| 90833, 90836 and 90838 add-ons | Add-ons to an E/M on the same day by the same prescriber. Services must be significant and separately identifiable. Source |
| 90791 and 90792 | 90791 is not reportable on the same day as an E/M by the same provider. 90792 is for prescribers only. Source |
| H0006 sunset | H0006 sunset on December 31, 2025. Source |
| Colorado edits | RAEs apply NCCI edits and, from October 1, 2025, Colorado-specific MUE and PTP edits. Source |
Colorado billing guide: what changed, newest first
Check this Colorado billing guide update log before you rely on an older rule.
| Date | What changed | Source |
|---|---|---|
| 2027-01-01 | Health First Colorado work requirement applies to applications and renewals on or after this date. | Source |
| 2026-07-14 | CMS released the CY2027 Medicare Physician Fee Schedule proposed rule: conversion factor $32.84 for non-qualifying APM participants (down 1.68%) and $33.17 for qualifying participants (down 1.19%). | Source |
| 2026-07-01 | RAEs begin reimbursing PRTF and QRTP youth residential services for child-welfare members. Those providers must contract with RAEs. | Source |
| 2025-12-31 | Procedure code H0006 sunset. | Source |
| 2025-10-01 | Colorado-specific MUE and PTP edits take effect for RAEs. | Source |
| 2025-08-01 | Anthem Colorado behavioral health authorizations move to Availity Essentials. | Source |
| 2025-07-01 | ACC Phase III begins with four RAEs replacing seven. | Source |
How do I bill mental health claims in Colorado?
These answers come from the same sources as the rest of this Colorado billing guide.
Start with the member's payer type. For Health First Colorado behavioral health, bill the member's RAE, and contract with that RAE first. Medicare Part B goes to Novitas Solutions in Jurisdiction H. Anthem Blue Cross and Blue Shield is the Blue licensee for commercial members, and Carelon Behavioral Health manages its behavioral health authorizations.
Questions about billing in Colorado
Who do I bill for Health First Colorado behavioral health claims?
Bill the RAE assigned to the member's region, after you contract with it. Members in Elevate Medicaid Choice or Rocky Mountain Health Plans PRIME are served through those plans.
What is the Health First Colorado timely filing limit?
365 days from the date of service for fee-for-service claims. Confirm RAE limits in each RAE contract.
When does the Colorado Medicaid work requirement start?
Health First Colorado says it applies to applications and renewals received on or after January 1, 2027.
Who manages Anthem behavioral health in Colorado?
Carelon Behavioral Health manages behavioral health utilization for Anthem Blue Cross and Blue Shield members in Colorado.
Does MCM South bill for practices in Colorado?
MCM South serves Colorado. Request a quote to talk through your practice.
Sources for the Colorado billing guide
Last checked October 25, 2026. Every source below was opened and read on that date.
- HCPF ACC Phase III, checked October 25, 2026
- HCPF ACC Phase III behavioral health provider fact sheet, checked October 25, 2026
- HCPF SBHS Billing Manual, January 2026, checked October 25, 2026
- HCPF Beginner Billing Professional, February 2026, checked October 25, 2026
- Health First Colorado work requirements FAQ, checked October 25, 2026
- CMS: MAC Jurisdiction H, checked October 25, 2026
- Anthem Colorado provider news, checked October 25, 2026
- Carelon Colorado quick reference guide, checked October 25, 2026
- Colorado Division of Insurance 2024 parity report, checked October 25, 2026
- C.R.S. 10-16-123, checked October 25, 2026
- C.R.S. 10-16-106.5, checked October 25, 2026
- CMS: CY2027 Physician Fee Schedule proposed rule fact sheet, checked October 25, 2026
- CMS MAC jurisdiction page, checked October 25, 2026
Related guides
- State & Regional Billing Guides hub
- Colorado insurance companies contact guide
- In-network vs out-of-network credentialing
- Credentialing and network status
- Blue Cross Blue Shield guide for Colorado
- Colorado Medicaid billing codes
- Mental health parity explained
- Medicaid managed care billing
- Medicare behavioral health billing
- Timely filing in the billing glossary
- Who we serve
- Texas insurance companies contact guide
Billing in Colorado? Let us handle the payer calls.
MCM South bills only mental and behavioral health, for psychotherapists and psychiatrists, in solo and medium-size practices. We serve Colorado.
MCM South currently serves practices in ten states: Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois.