C.R.S. § 25-49-101 Short title
25-49-101. Short title. The short title of this article 49 is the "Transparency in Health Care Prices Act".
Transparency in Health-care Prices
C.R.S. tit. 25, art. 49
in effectC.R.S. § 25-49-102 Definitions
25-49-102. Definitions. As used in this article 49, unless the context otherwise requires:
(1) "Agency" means a government department or agency or a government-created entity.
(2) "CPT code" means the current procedural terminology code, or its successor code, as developed and copyrighted by the American Medical Association or its successor entity.
(3) "Health-care facility" means a facility licensed or certified by the department of public health and environment pursuant to section 25-1.5-103. The term does not include a nursing care facility, assisted living residence, or home care agency.
(4) (a) "Health-care price" means the price, before negotiating any discounts, that a health-care provider or health-care facility will charge a recipient for health-care services that will be rendered. "Health-care price" is the price charged for the standard service for the particular diagnosis and does not include any amount that may be charged for complications or exceptional treatment. The health-care price for a specific health-care service may be determined from any of the following:
(I) The price charged most frequently for the health-care service during the previous twelve months;
(II) The highest charge from the lowest half of all charges for the health-care service during the previous twelve months; or
(III) A range that includes the middle fifty percent of all charges for the health- care service during the previous twelve months.
(b) "Health-care price" does not mean the amount charged if a public or private third party will be paying or reimbursing the health-care provider or health-care facility for any portion of the cost of services rendered.
(5) "Health-care provider" means a person who is licensed, certified, or registered by this state to provide health-care services or a medical group, independent practice association, or professional corporation providing health-care services.
(6) (a) "Health-care services" or "services" means services included in, or incidental to, furnishing to an individual:
(I) Medical, mental, dental, or optometric care or hospitalization; or
(II) Other services for the purpose of preventing, alleviating, curing, or healing a physical illness, an injury, or a mental health disorder.
(b) "Health-care services" includes services rendered through the use of telemedicine.
(7) "Health insurer" means a carrier, as defined in section 10-16-102 (8), disability insurer, group disability insurer, or blanket disability insurer.
(8) (a) "Public or private third party" means a health insurer, self-insured employer, or other third party, including a third-party administrator or intermediary, responsible for paying all or a portion of the charges for health-care services.
(b) "Public or private third party" does not mean:
(I) An employer of the recipient of the health-care services that is not responsible for paying the charges for the health-care services provided to the recipient;
(II) A person paying money from a health savings account, flexible spending account, or similar account; or
(III) A family member, charitable organization, or other person who is not responsible for, but pays charges for, health-care services on behalf of the recipient of the services.
(9) "Punish" means to impose a penalty, surcharge, fee, or other additional cost or measure that has the same effect as a penalty or that discourages the exercise of rights under this article 49.
(10) "Recipient" means an individual who receives health-care services from a health-care provider or health-care facility.
(11) "Self-pay" means payment without the assistance of a public or private third party.
C.R.S. § 25-49-103 Transparency - charges for services rendered by health-care providers
25-49-103. Transparency - charges for services rendered by health-care providers. (1) (a) (I) Except as provided in subsection (1)(a)(II) or (1)(a)(III) of this section, a health-care provider shall make available to the public, in a single document, either electronically or by posting conspicuously on the provider's website if one exists, the health-care prices for at least the fifteen most common health-care services the health-care provider provides. If the health-care provider, in the normal course of his or her practice, regularly provides fewer than fifteen health-care services, the health-care provider shall make available the health-care prices for the health-care services the provider most commonly provides.
(II) A health-care provider practicing in a solo practice or in a medical group, independent practice association, or professional corporation comprised of not more than six individual health-care providers with the same license type may comply with the requirements of this section by making the health-care prices described in subsection (1)(a)(I) of this section available in patient waiting areas.
(III) A health-care provider who is a member of a professional corporation that contracts with a single health maintenance organization, as defined in section 10-16-102 (35), complies with this section if the professional corporation or its contracting health maintenance organization makes available to the public, in a single document, either electronically or by posting conspicuously on its website, the health-care prices for at least the fifteen most common health-care services that the health-care provider or health maintenance organization would charge individuals who are not members of the health maintenance organization.
(b) The health-care provider shall identify the services by:
(I) A common procedural terminology code or other coding system commonly used by the health-care provider and accepted as a national standard for billing; and
(II) A plain English description.
(c) The health-care provider shall update the document as frequently as the health-care provider deems appropriate, but at least annually.
(2) The health-care provider shall include:
(a) A disclosure specifying that the health-care price for any given health-care service is an estimate and that the actual charges for the health-care service are dependent on the circumstances at the time the service is rendered; and
(b) The following statement or a statement containing substantially similar information:
If you are covered by health insurance, you are strongly encouraged to consult with your health insurer to determine accurate information about your financial responsibility for a particular health-care service provided by a health-care provider at this office. If you are not covered by health insurance, you are strongly encouraged to contact our billing office at (insert telephone number) to discuss payment options prior to receiving a health-care service from a health-care provider at this office since posted health-care prices may not reflect the actual amount of your financial responsibility.
(3) A hospital-based health-care provider that is not an employee of the hospital where the services are being delivered is not required to provide health-care prices in the manner specified in this section for the health-care services the health-care provider renders in the hospital setting.
(4) Nothing in this section precludes a health-care provider from informing a current or potential patient, upon request of the patient, of the health-care price for a health-care service that the health-care provider renders.
C.R.S. § 25-49-104 Transparency - health-care facility charges
25-49-104. Transparency - health-care facility charges. (1) (a) A health-care facility shall make available to the public, in a single document, either electronically or by posting conspicuously on its website if one exists, the health-care prices for at least:
(I) The fifty most used, diagnosis-related group codes or other codes for in-patient health-care services used by the health-care facility for billing or, if those codes are not used, the codes under another coding system for in-patient health-care services commonly used by the facility and accepted as a national standard for billing; and
(II) The twenty-five most used out-patient CPT codes or health-care services procedure codes used for billing or, if those codes are not used, the codes under another coding system for out-patient health-care services commonly used by the facility and accepted as a national standard for billing.
(b) If a health-care facility did not use fifty codes for in-patient health-care services at least eleven times in the previous twelve months or did not use twenty-five codes for out-patient health-care services at least eleven times in the previous twelve months, the health-care facility shall make available the health-care price for only those most common in-patient and out-patient health-care services or procedure codes that the health-care facility used at least eleven times in the previous twelve months.
(c) A health-care facility shall include with the health-care price provided pursuant to this subsection (1) a plain English description of the service for which the health-care price is provided.
(d) The health-care facility shall update the document as frequently as it deems appropriate, but at least annually.
(2) The health-care facility shall include:
(a) A disclosure specifying that the health-care price for any given health-care service is an estimate and that the actual charges for the health-care service are dependent on the circumstances at the time the service is rendered; and
(b) The following statement or a statement containing substantially similar information:
If you are covered by health insurance, you are strongly encouraged to consult with your health insurer to determine accurate information about your financial responsibility for a particular health-care service provided at this health-care facility. If you are not covered by health insurance, you are strongly encouraged to contact (insert office name and telephone number) to discuss payment options prior to receiving a health-care service from this health-care facility since posted health-care prices may not reflect the actual amount of your financial responsibility.
(3) A health-care facility may disclose the basis for its health-care prices and may take into consideration all payer sources when determining a health-care price.
C.R.S. § 25-49-105 No review of health-care prices - no punishment for exercising rights - no impairment of contracts
25-49-105. No review of health-care prices - no punishment for exercising rights - no impairment of contracts. (1) Nothing in this article 49 requires a health-care facility or health-care provider to report its health-care prices to any agency for review, filing, or other purposes, or for applications for health-care professional loan repayment submitted pursuant to section 25-1.5-503. This article 49 does not grant any agency the authority to approve, disapprove, or limit a health-care facility's or health-care provider's health-care prices or changes to its health-care prices. The department of public health and environment is not authorized to take any action regarding or pursuant to this article 49.
(2) This article 49 is intended to make health-care prices and payments, and participating in or exercising rights under this article 49, free from paperwork, punishment, reporting, and regulation to the fullest extent permissible under the state constitution and state and federal law. A person, entity, agency, or health insurer shall not punish a recipient, health-care provider, health-care facility, person, entity, or employer for participating directly in, exercising rights under, or complying with this article 49. The health-care price for a given health-care service that a health-care provider or health-care facility makes available to the public pursuant to this article 49 shall not be used as the basis for determining payment rates from a public or private third party for that health-care service.
(3) Nothing in this article 49 impairs contracts between private parties.
C.R.S. § 25-49-106 Required disclosure to self-pay recipients - estimate of total cost of health-care services upon request - deceptive trade practice - definition
25-49-106. Required disclosure to self-pay recipients - estimate of total cost of health-care services upon request - deceptive trade practice - definition. (1) (a) Upon the request of a person seeking a health-care service who intends to self-pay for the service, designated billing or patient services personnel representing a health-care provider or a health-care facility shall provide, prior to the provision of the health-care service, a self-pay estimate, pursuant to subsection (3) of this section, of the total estimated cost to the recipient of the anticipated health-care service, except as prohibited by 42 U.S.C. sec. 1395dd.
(b) (I) Except as provided in subsection (1)(b)(II) of this section, the final cost of the health-care service for which the self-pay estimate was made must be no more than fifteen percent higher than the total estimated cost indicated in the self-pay estimate or four hundred dollars, whichever is less.
(II) The final cost of the health-care service for which the self-pay estimate was made may be more than fifteen percent higher than the self-pay estimate or four hundred dollars if a medical emergency occurs that is associated with the health-care service or if an additional, unforeseen, medically necessary health-care service is required during the provision of the health-care service. The health-care provider or health-care facility shall make all reasonable efforts to obtain the consent of the recipient or, if the recipient is incapacitated, the recipient's authorized agent prior to providing any emergency or unforeseen, medically necessary health-care service that will increase by more than fifteen percent the total cost indicated in the self-pay estimate or four hundred dollars, whichever is less.
(2) The right of a person to request a self-pay estimate prior to the receipt of a health-care service must be clearly and conspicuously stated by the health-care provider and posted at the health-care facility in a manner, in a location, and at a time reasonably calculated to inform the person of the right.
(3) The self-pay estimate must:
(a) Be in writing or, if the health-care provider or health-care facility is unable to provide a written self-pay estimate, the self-pay estimate and the following information must be stated in a recorded telephone call:
(I) The date and time of the telephone call;
(II) The telephone number of the consumer receiving the self-pay estimate;
(III) The manner in which consent for the self-pay estimate amount must be provided by the intended recipient;
(IV) The name of the intended recipient of the health-care service;
(V) The name of the health-care provider or health-care facility employee providing the self-pay estimate; and
(VI) Any other information material to the determination of the self-pay estimate;
(b) Include the total estimated cost of the health-care service, including an itemization of all necessary components of the service, which components may include a facility fee and the cost of personnel, imaging, medical tools or devices, and medicine;
(c) Be easy to understand by a person without knowledge of medical or technical jargon and with limited proficiency in math, science, and written and oral communication skills;
(d) Be provided in English or Spanish, if requested by the consumer; and
y components of the service, which components may include a facility fee and the cost of personnel, imaging, medical tools or devices, and medicine;
(c) Be easy to understand by a person without knowledge of medical or technical jargon and with limited proficiency in math, science, and written and oral communication skills;
(d) Be provided in English or Spanish, if requested by the consumer; and
(e) Be provided within the following time frames:
(I) Not later than one business day after the date the primary item or service is scheduled if a primary item or service is scheduled at least three days before the primary item or service is provided;
(II) Not later than three business days after the date the primary item or service is scheduled if the primary item or service is scheduled at least ten business days before the primary item or service is provided; or
(III) Not later than three days after a request for a self-pay estimate.
(4) A provider or health-care facility that is in compliance with section 112 of Title I of division BB of the federal "No Surprises Act", and rules promulgated and determined by the federal centers for medicare and medicaid services under that act in 45 CFR 149.610, or any successor laws and regulations, is in compliance with this section.
(5) A violation of this section is a deceptive trade practice pursuant to section 6-1-105 (1)(yyy).
(6) As used in this section, "federal 'No Surprises Act'" means the federal "No Surprises Act", Pub.L. 116-260, as amended.
Source: Open US Law by Vaquill AI (CC BY 4.0)URL: https://leg.colorado.gov/sites/default/files/images/olls/crs2024-title-25.docxFetched: 10/6/2026