Colorado emergency department billing services
Professional ER billing for emergency medicine groups in Colorado: MDM-based 99281-99285 levels, critical care time, modifier 25, payer enrollment and No Surprises Act claims, built on the Colorado payer rules verified below.
What changes an ER claim in Colorado.
Every Colorado rule on file, each linked to its primary source: state surprise-billing law, Medicaid ER policy, Medicaid managed care, the Blue plan and the Medicare contractor.
| Rule type | Date | What it says | Source |
|---|---|---|---|
| State surprise-billing law | Aug 2026 | Colorado SB26-017 (signed May 28, 2026, effective Aug 12, 2026) requires carriers to send a remittance advice with each payment that flags state-regulated plans and out-of-network claims and states the carrier's median in-network rate, feeding the HB19-1174 arbitration process. | Source |
| Medicaid ER policy | Jul 2023 | Health First Colorado: physician and specialist co-pays are $0 since 7/1/2023 and emergency services are co-pay exempt; the only ED co-pay left is $8 per outpatient hospital non-emergent ER visit (facility claim). | Source |
| Medicare contractor | Aug 2026 | Medicare Part B professional ER claims go to Novitas Solutions, A/B MAC Jurisdiction H (JH). | Source |
How we bill Colorado ER visits.
The same four-step workflow we run for emergency medicine and hospitalist groups billing from their hospital system.
Hospital feed and registration
Demographics, insurance and the attending physician arrive from the hospital system daily. Gaps go back to registration as clarification requests, not guesses.
MDM levels and critical care minutes
ED visits 99281-99285 are coded on medical decision making only. Critical care is 99291 for 30 to 74 minutes and 99292 from 104 total minutes, on documented time.
Modifier 25 and enrollment check
A separately identifiable E/M on the day of a procedure carries modifier 25 with its own documentation. The rendering physician is checked against the payer roster before release.
Submission, remit and NSA/IDR
Professional claims go out with place of service 23. Out-of-network ER claims follow the No Surprises Act: in-network cost share only, open negotiation, then federal IDR.
FAQ: ER billing in Colorado.
Does Colorado have a state surprise billing law for ER care?
Colorado SB26-017 (signed May 28, 2026, effective Aug 12, 2026) requires carriers to send a remittance advice with each payment that flags state-regulated plans and out-of-network claims and states the carrier's median in-network rate, feeding the HB19-1174 arbitration process.
What does Colorado Medicaid require for ED visits?
Health First Colorado: physician and specialist co-pays are $0 since 7/1/2023 and emergency services are co-pay exempt; the only ED co-pay left is $8 per outpatient hospital non-emergent ER visit (facility claim).
Which Medicare contractor processes Colorado ER professional claims?
Medicare Part B professional ER claims go to Novitas Solutions, A/B MAC Jurisdiction H (JH).
How are emergency department visit levels chosen in Colorado?
By medical decision making only. CMS states that for emergency department visits practitioners use MDM, not time, to select 99281-99285, so the note must carry the problems addressed, the data reviewed and the risk of management.
Can an out-of-network ER physician in Colorado bill the patient for the balance?
Not for covered emergency services. Under the federal No Surprises Act, out-of-network providers of emergency services cannot bill the patient more than in-network cost sharing, and the notice-and-consent exception does not apply to emergency medicine.
Nearby ER billing state guides.
Neighbouring state pages with their own verified ER payer rules.