Use fee schedule values for billing — base value, conversion factor, allowable, ages

Fee schedule lists CDT procedure codes with columns for FFS base value, conversion factor, total Colorado Medicaid allowable (Base Value x Conversion Factor), and Min/Max age fields; the extract shows listed procedures are billable at the amounts and age ranges provided and contains no prior authorization instructions in this fragment.

• Columns shown: 1 = Procedure Code Description; 2 = FFS Base Value effective 07/01/2026; 3 = Conversion Factor; 4 = Total CO Medicaid Allowable; 5 = Min Age; 6 = Max Age (see [[chunk 0]] for column definitions).
• Example entries with allowable and age fields: D0120 $31.76 (Min 000 / Max 999), D0145 $33.56 (Max age 2) (see [[chunk 0]]).
• This extract does not include prior authorization rules or clinical coverage criteria (see [[chunk 0]] and [[chunk 36]]).

Bill using published rates; observe 'manually priced' notes

Fee schedule lists CDT/D-codes with specific reimbursement amounts and marks certain codes as manually priced; this fragment provides rates only and does not specify any prior authorization requirements.

• Sample rate lines: D2781 shown as $107.82 = $482.42; D2790 shown as $107.82 = $719.30 (see chunk 18).
• Entries flagged 'Code is manually priced' indicate reimbursement will be set manually rather than by the numeric schedule (see chunk 54).
• No prior authorization rules are present in these rate-only chunks (see chunk 18).

Bill prosthodontic partial denture codes at listed fees (D5221–D5223 etc.)

For prosthodontic partial denture codes D5221–D5223 (and related codes) use the listed dollar amounts when billing; the extract shows updated fee amounts and includes Min/Max age fields but does not provide prior authorization or documentation instructions in these lines.

• D5221 Immediate maxillary partial denture — $217.68 = $575.09; Min age 000 / Max age 20 (see chunk 36).
• D5222 Immediate mandibular partial denture — $217.68 = $575.09; Min age 000 / Max age 20 (see chunk 36).
• D5223 Denture — cast metal framework with resin bases — $217.68 = $823.67; Min age 000 / Max age 20 (see chunk 36).
• No prior authorization or documentation requirements are included in this prosthodontics fragment (see chunk 36).

Use fee schedule pricing excerpt for claim amounts; note manually priced entries

Fee schedule excerpt provides reimbursement amounts for listed CDT codes (including manually priced items) and should be used as the source of pricing when submitting claims; no authorization instructions appear in this pricing-only fragment.

• Manually priced examples with amounts: D6211 Code is manually priced = $471.83; D6751 Code is manually priced = $364.78 / $482.43 (see chunk 54).
• Surgical example rates: D7910 = $107.07 = $138.84; D7780 referenced with total allowable $3,722.41 (see chunk 72).
• This extract contains pricing and unit/age metadata but does not include prior authorization rules (see chunks 54 and 72).

Bill to published fee schedule; apply manual pricing notes where indicated

This section is a fee schedule listing CDT codes and prices only; providers must bill using the published allowable amounts or follow manual pricing where 'Code is manually priced' is indicated — the extract contains no prior authorization or submission requirements.

• Document header: rates effective 07/01/2026 and 'New Rates in Bold' (see chunk 0).
• Entries annotated 'Code is manually priced' require manual pricing application rather than the numeric fee column (see chunk 54).
• Billing should reflect the Total CO Medicaid Allowable (Base Value x Conversion Factor) and adhere to Min/Max age fields where shown (see chunk 0).