"The Colorado Medicaid reimbursement rates for evaluation and management procedure codes and vaccine administration procedure codes are changing. The Department reimbursed these codes at a Medicare equivalent rate to comply with Section 1202 of the Affordable Care Act (ACA) for calendar years 2013 and 2014, and temporarily extended the Medicare equivalent rate through June 2016. The funding to reimburse the evaluation and management and vaccine administration codes at a Medicare equivalent rate ends on June 30, 2016.
From July 1, 2016 through June 30, 2017, through the efforts of the Department and provider associations, one year of additional funding is authorized to reimburse several evaluation and management categories and vaccine administration at higher than the Medicaid rates in place in December 2012, prior to the implementation of Section 1202. The evaluation and management categories with temporary funding are:
· Standard office visits
· Preventive care office visits
· Newborn visits
· Neonatal and pediatric critical care visits
· Counseling visits
While rate changes take effect on July 1st, the Centers for Medicare and Medicaid Services (CMS) must approve changes to the Department’s State Plan before the rates may be paid. Due to the timing on CMS approval,
the new rates may not be paid starting on July 1. If needed, the Department will mass adjust all qualified claims in the system once CMS approval is received.
The FY16-17 reimbursement rates for these procedure codes are available online at
E&M_and Vaccine Code reimbursement. These rates are scheduled to return to the December 2012 level on July 1, 2017. Categories of evaluation and management that did not receive additional funding will be reimbursed at the December 2012 level starting July 1, 2016. These include emergency room visits, inpatient visits, critical care visits (excluding neonatal and pediatric critical care visits), home visits, when visits are prolonged, and standby/warfarin/interdisciplinary conference visits.
[Source:
HCPF]
