BH Group Practices Provider Type Changes to Billing Provider Eligibility

Reminder: Behavioral Health Group Practices Provider Type Guidance and Changes to Billing Provider Eligibility for Supportive Services

HCPF created Provider Type 77 - Behavioral Health Group, effective January 1, 2024 to create more network specificity for group practices who deliver behavioral health services. Many group providers are currently enrolled with Medicaid as a Non-Physician Practitioner Group (PT 25) or a Clinic Practitioner (PT 16). The PT 25 and PT 16 enrollments do not allow HCPF to differentiate between providers who primarily deliver behavioral health services, compared to those who primarily deliver medical services or integrated care.

Therefore, HCPF issued the following guidance for behavioral health group practices:

All newly enrolling group practice Medicaid providers that only deliver behavioral health services must enroll as PT 77 - Behavioral Health Group.

Current group practice Medicaid providers enrolled as PT 25 or PT 16 that only provide behavioral health services must re-enroll as a PT 77 upon revalidation or when making an update to their enrollment.

Effective July 1, 2026, PT 25 and PT 16 will no longer be able to bill for certain behavioral health supportive services. This change will be published in the July edition of the State Behavioral Health Services Billing Manual.

You can find Provider Enrollment resources on the HCPF Provider Enrollment webpage.

Email hcpf_bhbenefits@state.co.us with any questions regarding this guidance.