Colorado Rule 16 and 18 Changes

For 2026, the only rule changes thus far have been to Rule 18 and Rule 16.

The changes to Rule 18 largely deal with inflationary increases to the medical fee schedule. The Rule also now incorporates by reference the following:

• Medicare’s DMEPOS fee schedule for rural (R) or non-rural (NR) areas, January 2025
• Medicaid’s Health First Colorado Fee Schedule, January 1, 2025.
• Standard formats for electronic billing, remittance, and acknowledgments adopted by the U.S. Department of Health and Human Services (45 CFR Parts 160 and 162) pursuant to Health Insurance Portability and Accountability Act of 1996 (HIPAA)

The changes to Rule 16 deal with Exhibit #1, Utilization Standards. This exhibit provides guidance on the submission of bills and standardized forms and data entry required for providers to receive payment from payers.

There was a listening session for future changes to Rules 16 and 18 on April 9, 2026. This session focused on changes to rule 18 and offered stakeholders the opportunity to offer input on any technical, policy, or language considerations for the Division of Workers’ Compensation to review.

For the legislature, there are currently no pending changes to the Act. If any changes occur, we will provide updates as we learn of them.