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Fee Schedule & Reimbursement
What's the reimbursement for CHP+ primary care providers, specialty care providers, hospitals and ancillary?

Professional services are reimbursed on a fee-for-service basis in accordance with the CHP+ Fee Schedule and as specified in the CHP+ Provider Manual.

Below, please find the following fee schedules for contracted providers available for download:

Professional Fee Schedules:

Ambulance Fee Schedule
Immunization Fee Schedule
Behavioral Health Fee Schedules:  
  •   Behavioral Health Facility Relative Value Units
  •   Behavioral Health Non-Facility Relative Value Units
Professional Fee Schedule; Facility Relative Value Units
Professional Fee Schedule; Non-Facility Relative Value Units

Changes to Hospital/Facility reimbursement rates effective July 1, 2010

Hospital/Facility Providers:

Contracted Hospitals/Facilities
Non-Contracted Hospital/Facilities

Psychiatric Hospital Providers:

Contracted Psychiatric Hospitals
Non-Contracted Psychiatric Hospitals


Inpatient Hospital Services additional information:

The Department or its designees(s) shall reimburse a percentage calculation to the Contractor for all inpatient hospital Covered Services based on the Colorado Medicaid DRG reimbursement schedule as defined in 10 CCR 2505-10 8.300.5.A-D, unless otherwise specified in this Agreement.

Outpatient Hospital Services:

The Department or its designee(s) shall reimburse a percentage calculation to the Contractor for all outpatient Covered Services based on the Colorado Medicaid outpatient reimbursement methodology as defined in 10 CCR 2505-10 8.300.6.A.1 that is in effect on July 1st each year, without additional revision, unless otherwise specified in this Agreement.

Additional Reimbursement Information:

The reimbursement percentage calculation shall be updated on the CHP+ Provider Website annually on or about July 1st. The Department shall provide the Contractor with at least 120 days prior written notice of any change to the reimbursement amount specified on the CHP+ Provider Website.

When the Department or its designee(s) are made aware of an increase or decrease in the Contractor’s Medicare cost-to-charge ratio greater than or equal to five (5%) percent, then the Department will update the Contractor’s Medicare cost-to-charge ratio effective on the first of the month following notice from the Contractor.

The CHP+ Fee Schedule is based on the Centers for Medicare and Medicaid Service's (CMS) Resource Based Relative Value Scale (RBRVS) as adjusted for Colorado. CHP+ uses two separate conversion factors to calculate reimbursement: a) Medical/Surgical/Laboratory and b) Anesthesia. Most labs, durable medical equipment, and injectable drugs are paid on a flat fee basis. The Department may modify these rates during the term of this Agreement in accordance with changes in RBRVS by Medicare. In instances where the RBRVS method does not set unit values, CHP+ uses a modified Medicare fee schedule.

The allowed amounts listed do not guarantee payment for non-covered services. Please refer to the Provider Manual for questions regarding covered benefits.



State Managed Care Network Customer Service
PO Box 17580 Denver, CO 80217-0580
Phone: (303) 751-9051
Toll Free: 1-800-414-6198
Send claims to:
CHP+ Claims
PO Box 17470
Denver, CO 80217-0470