eConsults are not only a way to access timely specialist guidance, they are also a billable service for Medicaid providers.
Through the Colorado Medicaid eConsult platform, treating providers consult with specialists electronically and bill for the time spent preparing and submitting an eConsult, helping practices recognize and recoup effort already built into care coordination.
Billing for eConsults as the Treating Provider
Under Colorado Medicaid, treating providers may bill CPT code 99452 when submitting an eConsult. This code reflects:
- A provider-initiated clinical question
- Non-face-to-face consultation with a specialist
- A documented clinical question and summary of the case
- Time spent reviewing records and preparing the eConsult request (at least 16 minutes of time involved in total)
Billing CPT 99452 allows providers to be reimbursed for clinical decision-making and care coordination associated with eConsults.
What About the Consulting Specialist?
Specialists participating in the Colorado Medicaid eConsult program are reimbursed through the program’s specialty network and do not bill Medicaid directly for eConsults using CPT codes.
Why This Matters for Your Practice
Billing for eConsults helps practices:
- Capture revenue for care coordination time
- Reduce unnecessary referrals
- Improve access to specialist-informed care
- Support value-based and coordinated care efforts
Learn More
For billing details and guidance, providers should refer to HCPF’s official resources:
HCPF Telemedicine and eConsult Billing Manual
https://hcpf.colorado.gov/telemedicine-manual#eConsults
A Smarter, Billable Way to Coordinate Care
Colorado Medicaid eConsults support timely access to specialty guidance while allowing treating providers to bill for the time spent coordinating care. This helps practices deliver high-quality, specialist-informed care in a more sustainable way.