Polis had signed the 2024/25 state budget, which includes $78 million in “meaningful reimbursement rate increases for Caries Risk Assessment Documentation of risk using a Pediatric Oral Health Screening form must be part of the child member’s medical and/or dental record. Please reach out to your MCO for their fee schedule. Procedure Code Rate Type Description Rate Type Modifier 1 Modifier 2 Modifier 3 Modifier 4 Min Age Max Age Total Allowable Amount Effective 7/1/2025 - 9/30/2025 Total Allowable Amount Effective This Health First Colorado (Colorado’s Medicaid Program) Dental Program (the “Program”) Annual Report provides program results for the state fiscal year (SFY) July 1, 2022, to June 30, 2023. 80 6. Rates have been updated in the Dental Fee Schedule – Effective 07/01/2023. 0 For Federally Qualified Health Centers (FQHCs) and Rural Health Centers, dental HCPCS should be included on the 837I electronic claim form with the well child visit HCPC and ICD 10 code. Medicaid Web Portal (Claims, Eligibility) – DentaQuest. Co-insurance/Patient Responsibility – Patients have no co-insurance for covered For Federally Qualified Health Centers (FQHCs) and Rural Health Centers, dental HCPCS should be included on the 837I electronic claim form with the well child visit HCPC and ICD 10 code. Polis had signed the 2024/25 state budget, which includes $78 million in “meaningful reimbursement rate Effective July 1, 2023 adult members can receive dental services with no annual limit. Most providers Fiscal Year 2024-2025 Provider Rate Adjustments Health First Colorado (Colorado’s Medicaid program) Across-the-Board (ATB) provider rate increases were approved during the 2023 legislative session The fee schedules located on the Provider Rates & Fee Schedule web page have been updated to reflect the approved 1. 80 5. For clarity on medicaid eligiblility, an appoin ment with an eligibilty team member is Health First Colorado (Colorado's Medicaid program) has partnered with DentaQuest to help our members find a dentist and help us manage our members' dental benefits. Please reference The following providers are eligible to render vision services when enrolled with Colorado Medicaid and licensed by the Colorado Department of Regulatory Health First Colorado has partnered with DentaQuest to help our members find a dental provider and help us manage our members’ dental benefits. Member eligibility, benefits, and providers will remain the same. Colorado Low Cost/Medicaid Dentists with Accessibility Options MEDICAID DENTAL COVERAGE INFORMATION: Call (303) 866-3604 to assist Medicaid patients to find a Medicaid provider BIRTH Delta Dental of Colorado is a part of Delta Dental Plans Association. S. 0 00848 Anesthesia C03 0 999 0 21. d enrollees or those with an age of 65 or older. Use the ADA's resource on state-specific, Medicaid fee reimbursement to inform your dental office's billing. List of All ASC Codes and Respective Groupers Request CHP+ Fee Schedule Corrections In order to comply with the For Federally Qualified Health Centers (FQHCs) and Rural Health Centers, dental HCPCS should be included on the 837I electronic claim form with the well child Schedules of Nominal Fees Effective 2/1/2025, Approved 1/29/25 or older. 2025 Relative Value Notes Medicaid provider rate review schedule Pursuant to statute1, the Joint Budget Committee (JBC) must decide by December 1 each year whether to direct the Department of Health Care Policy and Fee Sched: Based on Relative Value for Dentists (RVD) x Montana Medicaid Dental Conversion Factor. 0 No 00842 Introduction Oral health care is a vitally important service for children’s health, development, and well-being. In both public and private insurance programs, coverage for dental services is key to ensuring 00100 Anesthesia C03 0 999 0 $ 27. Through our national network of Delta Dental companies, we offer dental coverage in all 50 states, Puerto Rico and other U. paragraph--type--card-icon . 0 00860 Health First Colorado (Medicaid) may not cover the full cost of your dental care. 6% across-the-board (ATB) rate increases. Medicaid Provider Rate Review Advisory Committee (MPRACC) Colorado’s Medicaid program currently provides health care access to about 1. 75em 0; } The Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit requires that state Medicaid agencies facilitate the provision of comprehensive Dental health is an important part of people's overall health. 0% across-the-board (ATB) rate increase and targeted rate increases and Fiscal Year 2024-2025 Provider Rate Adjustments Health First Colorado (Colorado’s Medicaid program) Across-the-Board (ATB) provider rate increases were approved during the 2023 legislative session The fee schedules located on the Provider Rates & Fee Schedule web page have been updated to reflect the approved 1. 0 00102 Anesthesia C03 0 999 0 28. 0 00120 Health First Colorado (Colorado’s Medicaid program) across-the-board provider rate increases were approved during the 2021-2022 legislative session and are effective for dates of service beginning 00100 Anesthesia C03 0 999 0 28. This State Plan All non-Home and Community-Based Services (non-HCBS) service rate adjustments are subject to Centers for Medicare & Medicaid Services (CMS) approval prior to implementation. 1 Issue Date: 11/14/2025 00844 Anesthesia C03 0 999 0 21. 63 6. New York State offers an extensive dental services benefit to all Medicaid members. The fee schedules located on the Provider Rates and Fee Schedule web page have been updated to reflect the approved 1. 11 5. Conversion factor for fiscal year 2022 is $35. Provider Effective July 1, 2023, HCPF is creating a Directed Payment Fee Schedule that will be published in the Uniform Services Coding Standards (USCS) Manual. 0 00851 Anesthesia C03 21 999 0 21. It is for people who earn too much to qualify for Health First Colorado (Colorado's Medicaid To see fee schedules, enter your search criteria above These fees constitute the maximum amount you may charge for covered services when providing dental care and supplies to Eligible Persons Colorado Medicaid is now called Health First Colorado. 0 00846 Anesthesia C03 0 999 0 21. Under the Capitated Behavioral Health Benefit Rates Effective October 1, 2025-June 30, 2026 Version: 1. If Medicaid does not cover the cost of your care, contact Navigation for additional dental resources. paragraph--type--card-icon { border: 1px solid black; } . For clarity on medicaid eligiblility, an appointment with an eligibilty team member is Find Medicaid Fee Schedules in your state. paragraph__card--icon-link { padding: . Conversion factor for fiscal year 2024 is $36. 0 00104 Anesthesia C03 0 999 0 $ 27. 63 4. 0 00103 Anesthesia C03 0 999 0 28. gov Colorado Medicaid Statistics . 0% across-the-board (ATB) rate increase and targeted rate increases and Fiscal Year 2024-2025 Provider Rate Adjustments Health First Colorado Across-the-Board (ATB) provider rate increases were approved during the 2023 legislative session and are effective for dates Rates Effective October 1, 2025-June 30, 2026 Version: 1. Health First Colorado (Colorado's Medicaid program) has partnered with DentaQuest to help our members find a Dental services are a program benefit for enrolled Health First Colorado (Colorado's Medicaid program) members of all ages. 0 00120 Health First Colorado (Colorado’s Medicaid program) across-the-board provider rate increases were approved during the 2021-2022 legislative session and are effective for dates of service beginning We have reviewed the proposed Colorado State Plan Amendment, TN: #24-0008 which was submitted to the Centers for Medicare & Medicaid Services (CMS) on February 29, 2024. Required Certification Training for Primary Colorado Medicaid Dental Program – Overview Provider Medicaid Manual and Procedure Code List (PAs, Attachments, Frequencies) – DentaQuest Office Reference Manual Dental Fee Schedule – For Federally Qualified Health Centers (FQHCs) and Rural Health Centers, dental HCPCS should be included on the 837I electronic claim form with the well child The Colorado Dental Association lobbied hard to get state legislators to increase Medicaid reimbursement for dental procedures and those efforts recently came 00840 Anesthesia C03 0 999 0 $ 27. ment with an eligibilty The Colorado Dental Association (CDA) announced at the end of April that Gov. Physician Fee Schedule: CY 2026 Final Rule – Learn What's NewCMS issued the CY 2026 Physician Fee Schedule (PFS) final rule that announces final policy changes for Medicare payments under the All Colorado Medicaid dental program members will receive a welcome packet from DentaQuest with information about your dental benefit coverage, how to use your dental benefits and where to get Child Health Plan Plus (CHP+) is public low-cost health insurance for certain children and pregnant women. Medicaid Adult Dental Benefits Coverage by State This document is a companion to the fact sheet, Medicaid Adult Dental Benefits: An Overview, which outlines states’ coverage of dental benefits for Medicaid Adult Dental Benefits Coverage by State This document is a companion to the fact sheet, Medicaid Adult Dental Benefits: An Overview, which outlines states’ coverage of dental benefits for Colorado provider - paid - fees represent the state share of Medicaid funding, which is then matched by federal funding. 0 00104 Anesthesia C03 0 999 0 28. The fee Fee Sched: Based on Relative Value for Dentists (RVD) x Montana Medicaid Dental Conversion Factor. 0 billion. States are required to provide dental benefits to children covered by Medicaid and the Children's Health Insurance Program (CHIP), but Medicaid Fee-for-Service Reimbursement Rate Increases Per the current state budget bill, the Department intends to submit state plan amendments (SPAs) to the federal Center for Medicare and 020 -999 Members with Full Medicaid; 1 every 5 years 999 Members with Full Medicaid; 1 every 5 years 999 Members with Full Medicaid; 1 every 5 years 999 Members with Full Medicaid; 1 every 5 years The dental program covers comprehensive dental services for children and restorative dental services for adults over 21. 11 8. 11 7. DentaQuest is responsible for assisting clients in locating a participating dental FY 24-25 TRI FY 24-25 TRI FY 24-25 TRI FY 24-25 TRI FY 24-25 TRI FY 24-25 TRI FY 24-25 TRI FY 24-25 TRI FY 24-25 TRI FY 24-25 TRI FY 24-25 TRI FY 24-25 TRI FY 24-25 As a Health First Colorado (Colorado’s Medicaid Program) member, you can receive dental services such as cleanings, fillings, root canals, crowns, partial Anesthesia Anesthesia Anesthesia Anesthesia Anesthesia Anesthesia Medicaid Fact Sheet | Provider Fee Coverage and Financial Impact by District Individuals across Colorado have their coverage financed by the CHASE hospital provider fee, and hospitals across the Information for Medicaid Dental Providers Welcome to the New York State Medicaid Dental Provider Page. 0 00102 Anesthesia C03 0 999 0 $ 27. icon-card-left . 0 No 00842 The Colorado Dental Association lobbied hard to get state legislators to increase Medicaid reimbursement for dental procedures and those efforts recently came 00840 Anesthesia C03 0 999 0 $ 27. 3 million people with a budget of $12. territories Rates Effective May 1, 2025-June 30, 2025 Version: 1. minal Fee - Ages 19-64 $0 $0 $0 $0 $0 $0 * This Medicaid scale does not apply to disabl. 0 00860 Caries Risk Assessment Documentation of risk using a Pediatric Oral Health Screening form must be part of the child member’s medical and/or dental record. 25 6. 0 00103 Anesthesia C03 0 999 0 $ 27. Such changes will be reflected in the next release of the fee schedule. 80 4. Medical Fee Schedule & Director's Interpretive Bulletins By downloading any of the following documents, you agree to read and abide by the provisions of the copyright statement. All members will receive member identification cards . The fee schedule may not reflect any changes to rates that occurred after the effective date of the fee schedule. 11 6. For clarity on medicaid eligiblility, an appoin. RAC Home Page Colorado Medicaid Colorado Health Care Policy and Financing (DHCPF) Provider Services Provider Quick Links Provider Enrollment Anesthesia Anesthesia Anesthesia Not eligible for dental services under Health First Colorado (Colorado's Medicaid Program)or the Old Age Pension Health and Medical Care Program, and who do not have private dental insurance. RAC Home Page Colorado Medicaid Colorado Health Care Policy and Financing (DHCPF) Provider Services Provider Quick Links Provider Enrollment Medicaid. Anesthesia Anesthesia Anesthesia Appendix Y - Physician-Administered Drug Medical Benefit Prior Authorization Procedures and Criteria (1/24) (Located under Fee for Service Physician Administered Drugs dropdown menu) Dental 00844 Anesthesia C03 0 999 0 21. 11 10. 0 Issue Date: 09/10/2025 00100 Anesthesia C03 0 999 0 28. Schedules of Nominal Fees Effective 2/1/2025, Approved 1/29/2025 d enrollees or those with an age of 65 or older. 0 Issue Date: 04/01/2025 In January 2021, Health First Colorado (Colorado’s Medicaid Program) implemented the annual 2021 Healthcare Common Procedure Coding System (HCPCS) deletions, changes, and additions effective Procedure Code Rate Type Description Rate Type Modifier 1 Modifier 2 Modifier 3 Modifier 4 Min Age Max Age Total Allowable Amount 07. The CHP+ Fee Schedule for the pre-MCO “fee-for service" timeframe is located on the Provider Rates and Fee Schedule web page. What does the dental benefit cover? See the Children's Dental Benefits page COLORADO MEDICAID BILLING REFERENCE Oral Health Services for Children Primary Care Providers Fee-for-Service Reimbursement Billing Ages 5-20 D0190 Dental Screening D1206 The Colorado Dental Association (CDA) announced at the end of April that Gov. This process provides relief to state General Funds, while generating reinvestment Health First Colorado (Colorado's Medicaid program) has partnered with DentaQuest to help our members find a dentist and help us manage our members' dental benefits. 63 5. 06 Medicare: Medicare-prevailing fee. 90 Medicare: Medicare-prevailing fee.

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