Colorado Therapist Billing: OON Reimbursement Guide

Colorado has a robust and competitive therapy market, with high demand for mental health services concentrated in the Denver metro and Front Range corridor. DORA-regulated therapists navigating the state's OON landscape need to understand Kaiser's significant presence and the mechanics of OON reimbursement in a market where many clients are sophisticated healthcare consumers.

Overview

Colorado therapists benefit from a well-insured population and relatively high private-pay rates, particularly along the Front Range. Issuing compliant superbills and helping clients understand their OON benefits is a key part of building a sustainable private practice in Colorado's competitive market.

Colorado Licensing (DORA)

Mental health professionals in Colorado are licensed by the Department of Regulatory Agencies (DORA), specifically the Mental Health Licensing Section. Colorado has several license types relevant to OON billing:

• LCSW — Licensed Clinical Social Worker
• LPC — Licensed Professional Counselor
• LMFT — Licensed Marriage and Family Therapist
• Licensed Psychologist — Doctoral level
• LPCC — Licensed Professional Counselor Candidate (supervised; limited independent billing rights)

DORA also licenses Licensed Addiction Counselors (LAC) and Certified Addiction Counselors (CAC), though insurance billing rights for addiction-focused services vary by payer. Your DORA license number, NPI, and taxonomy code must appear on every superbill.

Colorado Insurance Landscape

Colorado's insurance market is moderately concentrated, with a few key payers:

• Anthem Blue Cross Blue Shield Colorado — One of the largest commercial payers in Colorado. PPO plans include OON mental health benefits; clients submit superbills through the Anthem member portal or by mail.
• Kaiser Permanente Colorado — Kaiser has a very substantial presence in Colorado, particularly in the Denver metro. Kaiser's HMO structure means there are generally no OON benefits for psychotherapy. Clients on Kaiser plans typically cannot submit superbills for reimbursement unless they have a single case agreement.
• UnitedHealthcare — Common in employer-sponsored plans. OON claims via myuhc.com; standard OON mental health benefits on PPO plans.
• Aetna — Present in employer plans and Connect for Health Colorado Marketplace plans. OON benefits on PPO plans.
• Cigna / Evernorth — Common among tech employers in Denver. PPO plans have OON mental health benefits; prior authorization sometimes required for extended treatment.
• Rocky Mountain Health Plans — Regional carrier serving Western Slope and Grand Junction area; limited OON mental health benefits.

Kaiser's dominance is an important factor for Colorado therapists. If a significant portion of your potential clients are on Kaiser plans, consider whether pursuing Kaiser credentialing makes sense for your practice alongside an OON strategy.

Telehealth Rules

Colorado has enacted strong telehealth parity protections. SB 19-144 and subsequent legislation require commercial insurers to cover telehealth services for mental health at parity with in-person care. Billing notes:

• Use Place of Service 10 for client-in-home telehealth sessions
• Colorado does not require a geographic restriction for telehealth — clients can be anywhere in Colorado during their session
• Colorado participates in the PSYPACT interstate compact for psychologists, allowing licensed psychologists to provide telehealth across member states

See our telehealth billing guide for details on Place of Service codes and modifiers.

Reimbursement Rates

Estimated OON reimbursement for CPT 90837 (60-minute session) in Colorado:

• Denver / Boulder: Private pay $160–$270; OON reimburse ~$75–$130
• Fort Collins / Colorado Springs: Private pay $140–$220; OON reimburse ~$65–$110
• Mountain resort towns (Aspen, Vail, Telluride): Private pay $200–$350; OON reimburse ~$90–$150
• Western Slope / Grand Junction: Private pay $120–$180; OON reimburse ~$55–$95

Tips for Colorado Therapists

• Ask about Kaiser before scheduling. When a prospective client contacts you, ask which insurance plan they have before the first appointment. Kaiser clients typically cannot use OON superbills, which is worth clarifying early to avoid confusion about billing.
• Understand Connect for Health Colorado plans. Colorado's state Marketplace (Connect for Health Colorado) offers both HMO and PPO plans. Marketplace PPO plans typically have OON benefits; Marketplace HMO plans do not.
• Colorado parity protections are strong. Colorado follows federal MHPAEA parity and has additional state requirements. If a client's plan appears to be applying stricter limitations to mental health than to medical services, they can file a complaint with the Colorado Division of Insurance.

Generate Your Colorado Superbill

Superbilled helps Colorado therapists generate HIPAA-compliant superbills quickly and accurately. Visit our Colorado superbill generator to create your practice profile and start generating superbills today.