JULY 2025

Coding Changes for Specific Provider Types

Some changes effective July 1, 2025, are relevant to specific provider types: peer services, substance use disorder (SUD), comprehensive safety net providers (CSNP), and recovery support services organization (RSSO). Please read below for additional details on the changes.

Peer Providers

• As shared in the previous policy transmittal, effective July 1 you must be a SUD, CSNP, or RSSO provider type to bill H0038 and H0023. If you are not one of those provider types, you can no longer have a peer render the service and bill these codes. Your claims will be denied.

• Peers cannot be the rendering provider for H2014 for any billing provider type.

• If you have additional questions on what provider types are able to bill for specific services, please reference the billing manual: State Behavioral Health Services Billing Manual | Department of Health Care Policy and Financing

SUD/CSNP/RSSO

• Effective July 1, as HCPF as previously communicated, Colorado will be utilizing NCCI edits.

• H2023 will have a maximum medically unlikely edits (MUE) of 8 units per day when medically necessary

• H0038 will have a MUE of 12 units per day when medically necessary

• Service billed in excess of the CO MUE will have a denial message regarding the MUE limit being exceeded; providers have a right to appeal and submit any necessary clinical documentation, in order to determine if more units should be allotted.

• For additional information on NCCI edits please reference this document: Medicare NCCI Procedure to Procedure (PTP) Edits | CMS

If you have any questions, please contact your provider network services representative, or email us at providernetworkservices@coaccess.com.