Do not confuse statewide references with a practice’s agreement
A Colorado practice needs its own executed fee schedules even when using a statewide Medicare reference. A common reference geography does not mean that Denver and Colorado Springs practices have identical commercial terms. Use Colorado Division of Insurance guidance to identify coverage and oversight questions.
- What part of the comparison is a government reference, and what part is verified commercial contract evidence?
What a Colorado contract review should establish
Identify executed agreements, later amendments, fee schedules and notice deadlines. Commercial contracts more than five years old are eligible for renegotiation screening; the agreement’s renewal and amendment provisions still govern the process. Higher rates are not guaranteed.
- Which plan products and providers does the agreement cover?
- Which high-volume codes have matched comparison evidence, and which remain unbenchmarked?
- What notice or amendment steps are required before contacting the payer?
National references are not verified local rates
NPAG’s online tools currently use national commercial reference figures for supported codes. They do not show verified state-specific or payer-product-specific offers. A practice-specific comparison must match code, date, locality, network and service setting.
CMS geography is useful when an agreement references Medicare. It is not proof of commercial negotiating leverage. State provider guidance is a starting point for applicable processes, not legal advice or a promise of a new fee schedule.
Official sources and further reading
- Colorado DOI: commercial insurance resources for providers
Provider-specific guidance and regulatory scope. The consumer complaint portal is not the default channel for provider complaints.
- CMS Physician Fee Schedule locality key
Check the applicable year and service location. Medicare geography does not establish commercial negotiated rates.
NPAG editorial review · October 13, 2026 · Sourcing and corrections