MedicaidBilling CodesMedium impact
Special Provider Bulletin - Long Acting Injectable Antipsychotics(B2000446 - 03/2020)
Colorado Medicaid·CO · Psychiatry, Family Medicine, Internal Medicine·Provider Bulletin
Effective date
Mar 1, 2020
We identified it
Jun 20, 2026
Summary
Colorado Medicaid (Health First Colorado) has issued billing guidelines for Long Acting Injectable Antipsychotics (LAIs). These drugs must be billed as physician services using specific HCPCS/NDC combinations from Appendix X, with payment based on Medicare Average Sales Price minus 3.3%. Patients cannot obtain LAIs from pharmacies for office administration.
Action Required
Immediately: Billing team must reference Appendix X monthly for valid HCPCS/NDC combinations when billing LAIs. Use the Crosswalk to determine correct HCPCS units by dividing dose administered by HCPCS description units. Verify NDC matches drug label exactly or claims will be denied. Update billing software to require both HCPCS code and 11-digit NDC for all physician administered drugs.