DEPARTMENT OF LABOR AND EMPLOYMENT
Division of Workers’ Compensation
PROPOSED CHANGES FOR EFFECTIVE DATE January 1, 2011
Rule 16           UTILIZATION STANDARDS
16-1      STATEMENT OF PURPOSE
            In an effort to comply with its legislative charge to assure appropriate and timely medical care at a reasonable cost, the Director (Director) of the Division of Workers' Compensation (Division) has promulgated these utilization standards, effective January 1, 2011 2010.  This rule defines the standard terminology, administrative procedures and dispute resolution procedures required to implement the Division's Medical Treatment Guidelines and Medical Fee Schedule.  With respect to any matter arising under the Colorado Workers' Compensation Act and/or the Workers' Compensation Rules of Procedure and to the extent not otherwise precluded by the laws of this state, all providers and payers shall use and comply with the provisions of the "Medical Treatment Guidelines," Rule 17, and the "Medical Fee Schedule," Rule 18, as incorporated and defined in the Workers' Compensation Rules of Procedure, 7 CCR 1101-3.
16-4      REQUIRED USE OF THE MEDICAL FEE SCHEDULE
(A)	When services provided to an injured worker fall within the purview of the medical fee schedule, all payers shall use the fee schedule to determine maximum allowable fees.
(B)	All providers are required to report services in accordance with codes and standards in Rule 18 Medical Fee Schedule that accurately represent the services provided.  The medical fee schedule sets the maximum allowable payment but the fee schedule does not limit the billing charges.
(C)	The provider may be subject to penalties under the Workers’ Compensation Act for inaccurate billing when the provider knew or should have known that the services billed were inaccurate, as determined by the Director or an administrative law judge.
16-5      RECOGNIZED HEALTH CARE PROVIDERS
(A)        Physician and Non-Physician Providers
(1)        For the purpose of this rule, recognized health care providers are divided into the major categories of "physician" and "non-physician".  Recognized providers are defined as follows:
(b)        "Non-physician providers" are those individuals who are registered or licensed by the State of Colorado Department of Regulatory Agencies, or certified by a national entity recognized by the State of Colorado as follows:
(4)	Audiologist (AU.D., CCC-A) – certified by the American Speech Language-Hearing Speech/Language and Hearing Association or board certified in audiology from the American Board of Audiology;
(19)       Speech Language Pathologist (CCC-SLP) – certified by the American Speech Language-Hearing and Hearing Association; and
16-7      REQUIRED BILLING FORMS AND ACCOMPANYING DOCUMENTATION
(B)        Required Billing Forms
(2)        UB-04 - shall be used by all hospitals, hospital-based ambulance/air services, Children’s Hospitals, CAHs, Veterans’ Administration Facilities, home health and facilities meeting the definitions found in Rule 16-2 when billing for hospital services or any facility fees billed by any other provider, such as ASCs, except for urgent care which may use the CMS 1500 (08-05).
(C)        Required Billing Codes
            All billed services shall be itemized on the appropriate billing form as set forth in Rule 16-7(A) and (B), and shall include applicable billing codes and modifiers from the fee schedule.  Currently nNational provider identification (NPI) numbers are not required for workers’ compensation bills; providers who are not permitted to obtain NPI numbers are exempt from this requirement.  When billing on a CMS 1500 (08-05), the NPI should be that of the rendering professional at the line level whenever possible.
 (E)        Accompanying Documentation
(1)        Authorized treating physicians sign (or countersign) and submit to the payer, with their initial and final visit billings, a completed “Physician’s Report of Workers’ Compensation Injury” (Form WC164) specifying:  
(a)        The report type as “initial” when the injured worker has their initial visit with the authorized treating physician managing the total workers’ compensation claim of the patient.  Generally, this will be the designated or selected authorized treating physician.  When when applicable, the emergency room or urgent care authorized treating physician for this workers’ compensation injury may also create a WC 164 initial report.  Unless requested or prior authorized by the payer in a specific workers’ compensation claim, no other authorized physician should complete and bill for the initial WC 164 form.  This form shall include completion of items 1-7 and 10.  Note that certain information in item 2 (such as Insurer Claim #) may be omitted if not known by the provider.
16-11    PAYMENT OF MEDICAL BENEFITS
(A)        Payer Requirements for Processing Medical Service Bills
(1)	For every medical service bill submitted by a provider, the payer shall reply with a written notice or explanation of benefits.   In those instances where the payer reimburses the exact billed amount, identification of the patient’s name, the payer, the paid bill, the amount paid and the dates of service are required.  If any adjustments are made then the payer’s written notice shall include: 
(i)	Nname, address, e-mail (if any), phone number and fax of a person who has responsibility and authority to discuss and resolve disputes on the bill;
(j)	Name and address of the employer, when known;
 (k j)	If applicable, a statement that the payment is being held in abeyance because a relevant issue is being brought to hearing.
(F)	Retroactive review of Medical Bills
(1)        All medical bills paid by a payer shall be considered final at twelve months after the date of the original explanation of benefits unless the provider is notified that:
(a)	a hearing is requested within the twelve month period, or and
(b)	a request for utilization review has been filed pursuant to § 8-43-501.  the requesting provider is notified that the payment is being contested and the matter is going to hearing, or
(2)        If the payer conducts a retroactive review to recover overpayments from a provider based on medical reasons, the payer shall have the bill and all supporting documentation reviewed by a physician or other health care professional as defined in Rule 16-5(A)(1)(a), who holds a license and is in the same or similar specialty as would typically manage the medical condition, procedures, or treatment under review.  The payer shall send the billing party written notice that shall include all of the notice requirements set forth in 16-11(A)(1) and shall also include:
(b)	Clear and persuasive medical reason(s) for seeking recovery of overpayment(s).  The explanation shall include the citing of appropriate statutes, rules, and/or other documents supporting the payer’s reason for seeking to recover overpayment; and
(3)	If the payer conducts a retroactive review to recover overpayments from a provider based on non-medical reasons, the payer shall send the billing party written notice that shall include all of the notice requirements set forth in 16-11(A)(1) and shall also include:
(b)	Clear and persuasive reason(s) for seeking recovery of overpayment(s).  The explanation shall include the citing of appropriate statutes, rules, and/or other documents supporting the payer’s reason for seeking to recover overpayment; and 

DEPARTMENT OF LABOR AND EMPLOYMENT
Division of Workers’ Compensation
PROPOSED CHANGES FOR EFFECTIVE DATE January 1, 2011
Rule 18          MEDICAL FEE SCHEDULE
18-1      STATEMENT OF PURPOSE
Pursuant to § 8-42-101(3)(a)(I) C.R.S. and Section 8-47-107, C.R.S., the Director promulgates this medical fee schedule to review and establish maximum allowable fees for health care services falling within the purview of the Act.  The Director adopts and hereby incorporates by reference as modified herein the 2010 2009 edition of the Relative Values for Physicians (RVP©), developed by Relative Value Studies, Inc., published by Ingenixâ St. Anthony Publishing, the Current Procedural Terminology CPT®  2010 2009, Professional Edition, published by the American Medical Association (AMA) and Medicare Severity Diagnosis Related Groups (MS-DRGs) Definitions Manual, Version 28.0 27.0 developed and published by 3M Health Information Systems using MS-DRGs effective after October 1, 2010 2009.  The incorporation is limited to the specific editions named and does not include later revisions or additions.  For information about inspecting or obtaining copies of the incorporated materials, contact the Medical Fee Schedule Administrator, 633 17th Street, Suite 400, Denver, Colorado 80202-3626.  These materials may be examined at any state publications depository library.  All guidelines and instructions are adopted as set forth in the RVP©, CPT® and MS-DRGs, unless otherwise specified in this rule.
This rule applies to all services rendered on or after January 1, 2011 2010.  All other bills shall be reimbursed in accordance with the fee schedule in effect at the time service was rendered.
18-2      STANDARD TERMINOLOGY FOR THIS RULE
(A)        CPTâ - Current Procedural Terminology CPTâ 2010 2009, copyrighted and distributed by the AMA and incorporated by reference in Rule 18-1.
(C)        MS-DRGs – version 28.0 27.0 incorporated by reference in Rule 18-1.
(D)        RVP© – the 2010 2009 edition incorporated by reference in Rule 18-1.
18-3      HOW TO OBTAIN COPIES
All users are responsible for the timely purchase and use of Rule 18 and its supporting documentation as referenced herein.  The Division shall make available for public review and inspection copies of all materials incorporated by reference in Rule 18.  Copies of the RVP© may be purchased from Ingenixâ St. Anthony Publishing, the Current Procedural Terminology, 2010 2009  Edition may be purchased from the AMA, the MS-DRGs Definitions Manual may be purchased from 3M Health Information Systems, and the Colorado Workers' Compensation Rules of Procedures with Treatment Guidelines, 7 CCR 1101-3, may be purchased from LexisNexis Matthew Bender & Co., Inc., Albany, NY.  Interpretive Bulletins and unofficial copies of all rules, including Rule 18, are available on the Colorado Department of Labor and Employment web site at www.coworkforce.com/DWC/ .  An official copy of the rules is available on the Secretary of State’s webpage http://www.sos.state.co.us/CCR/NumericalCCRDocList.do?deptID=10&deptName=1100%20Department%20of%20Labor%20and%20Employment&agencyID=135&agencyName=1101%20Division%20of%20Workers'%20Compensation .(Last accessed September 1, 2009)  .
18-4      CONVERSION FACTORS (CF)
The following CFs shall be used to determine the maximum allowed fee.  The maximum fee is determined by multiplying the following section CFs by the established relative value unit(s) (RVU) found in the corresponding RVP© sections:
RVP© SECTION                                                         CF
Physical Medicine                                              $  5.90 73/RVU
            Physical Medicine and Rehabilitation, Medical Nutrition Therapy and Acupuncture
Evaluation & Management (E&M)                     $   9.62 16/RVU
18-5      INSTRUCTIONS AND/OR MODIFICATIONS TO THE DOCUMENTS INCORPORATED BY REFERENCE IN RULE 18-1 
(B)        Unless modified herein, the RVP© is adopted for RVUs and reimbursement.  Interim relative value procedures (marked by an “I” in the left-hand margin of the RVP©) are accepted as a basis of payment for services; however deleted CPT® codes (marked by an “M” in the RVP©) are not, unless otherwise advised by this rule.  The CPT® 2010 2009 is adopted for codes, descriptions, parenthetical notes and coding guidelines, unless modified in this rule. 
(D)        Surgery/Anesthesia
(1)        Anesthesia Section:
(d)        Surgery X Procedures 
(1)        The surgery X procedures are limited to those listed below and found in the table under the RVP©, Anesthesia section’s Guidelines XIII, “Anesthesia Services Where Time Units Are Not Allowed”:
·         Providing local anesthetic or other medications through a regional IV
·         Daily drug management
·         Endotracheal intubation
·         Venipuncture, including cutdowns
·         Arterial punctures
·         Epidural or subarachnoid spine injections
·         Somatic and Sympathetic Nerve Injections 
·         Paravertebral facet joint injections and rhizotomies
In addition, lumbar plexus spine anesthetic injection, posterior approach with daily administration = 7 RVUs; paravertebral facet, zygapophyseal joint or nerves with guidance are reimbursed at 10 RVUs for a single level of the cervical or thoracic, 5 RVUs for second level or more, and 8 RVUs for the lumbar or sacral single level, 4 RVUs for the second level or more.
(2)        Surgical Section: 
(a)        The use of assistant surgeons shall be limited according to the American College Of Surgeons'  Physicians as Assistants at Surgery:  2007 Study (January 2007), available from the American College of Surgeons, Chicago, IL, or from their web page at http://www.facs.org/ahp/pubs/2007physasstsurg.pdf (accessed September 1, 2009).  The incorporation is limited to the edition named and does not include later revisions or additions.  Copies of the material incorporated by reference may be inspected at any State publications depository library.  For information about inspecting or obtaining copies of the incorporated material, contact the Medical Fee Schedule Administrator, 633 17th Street, Suite 400, Denver, Colorado, 80202-3626.  
(f)         Global Period 
(1)        The following services performed during a global period would warrant separate billing if documentation demonstrates significant identifiable services were involved, such as:
¨         If a patient is seen for the first time or an established patient is seen for a new problem and the “decision for surgery” is made the day of the procedure or the day before the procedure is performed, then the surgeon can bill both the procedure code and an E&M code, using a 57 modifier or 25 modifier on the the E&M code.
(i)	If a surgical arthroscopic procedure is converted to the same surgical open procedure on the same joint, only the open procedure is payable.  If an arthroscopic procedure and open procedure are performed on different joints, the two procedures may be separately payable with anatomic modifiers or modifier 50.
(j)	Use code G0289 to report any combination of surgical knee arthroscopies for removal of loose body, foreign body, and/or debridement/shaving of articular cartilage.  G0289 is 11.2 RVUs and is paid using the surgical conversion factor.
	G0289 shall not be paid when reported in conjunction with other knee arthroscopy codes in the same compartment of the same knee.
	G0289 shall be paid when reported in conjunction with other knee arthroscopy codes in a different compartment of the knee.  G0289 is subject to the 50% multiple surgical reduction guidelines.
 (E)        Radiology Section: 
(1)        General
(a)        The cost of dyes and contrast shall be reimbursed in accordance with Rule 18-6(H).  at 80 % of billed charges.
(G)        Medicine Section: 
(4)        Appendix J of the 2010 2009 CPTâ identifies mixed, motor and sensory nerve conduction studies and their appropriate billing.  
(H)        Physical Medicine and Rehabilitation: 
(7)        Evaluation Services for Therapists:  Physical Therapy (PT), Occupational Therapy (OT) and Athletic Trainers (ATC) (cf. §12-36-106 C.R.S.) 
(b)        Payers are only required to pay for evaluation services directly performed by a PT, OT, or ATC as defined in Title §12-36-106 of the C.R.S.  All evaluation notes or reports must be written and signed by the PT or OT.  Physicians shall bill the appropriate E&M code from the E&M section of the RVP©.
(8)        Special Tests 
(a)        Billing Restrictions:
(1)        Job Site Evaluations require prior authorization for payment (see Rule 16-9 and 16-10) if exceeding 2 hours. Computer-Enhanced Evaluations, and Work Tolerance Screenings require prior authorization for payment for more than 4 hours per test or more than 6 tests per claim.  Functional Capacity Evaluations require prior authorization for payment for more than 4 hours per test or 2 tests per claim.
(14)       Work Conditioning, Work Hardening, Work Simulation
(d)        For Work Conditioning, Work Hardening, or Work Simulation, the following apply.
(3)      	Provider Restrictions:  All procedures must be performed by or under the onsite supervision of a physician, psychologist, PT, OT, speech language pathologist or audiologist.
18-6      DIVISION ESTABLISHED CODES AND VALUES 
(E)        Mileage Expenses
The payer shall reimburse an injured worker for reasonable and necessary mileage expenses for travel to and from medical appointments and reasonable mileage to obtain prescribed medications.  The reimbursement rate shall be 47 52  cents per mile.  The injured worker shall submit a statement to the payer showing the date(s) of travel and number of miles traveled, with receipts for any other reasonable and necessary travel expenses incurred.  
Mileage Expense Billing Code:    DoWC Z723 
(G)        Report Preparation
(4)        Special Reports
Special Report Maximum Fees: 	$325.00 per hour.
	Billed in 15- minute half hour increments.
(5) 	Chronic Opioid Management Report 
(a)	When the authorized treating physician prescribes long-term opioid treatment, s/he shall use the Division of Workers’ Compensation Chronic Pain Disorder Medical Treatment Guidelines and also review  the Colorado State Board of Medical Examiners’  Policy # 10-14, “Guidelines for the Use of Controlled Substances for the Treatment of Pain.”  Urine drug tests Drug Tests for chronic opioid management shall employ testing methodologies that meet or exceed industry standards for sensitivity, specificity and accuracy.  The test methodology must be capable of identifying and quantifying the parent compound and relevant metabolites of the opioid prescribed.  In-office screening tests designed to screen for drugs of abuse are not appropriate for chronic opioid compliance monitoring.  
(2)	When drug screen tests are ordered, the authorized treating physician shall utilize the Colorado Prescription Drug Monitoring Program (PDMP) program.
(3)	While the injured worker is receiving chronic opioid management, additional drug screens with documented justification may be conducted.  Examples of documented justification include the following:
(iv) 	Chronic chronic daily opioid dosage above 150 mg of morphine or equivalent
(b)	Codes and maximum fees for the authorized treating physician for a written report with all the following review services completed and documented:
(1)	Oordering and reviewing drug tests
(2)	Oordering and reviewing PDMP results
(3)	Reviewing the medical records
(4)	Reviewing the injured workers’ current functional status
(5)	Ddetermining what actions, if any, need to be taken
(6)	Appropriate chronic pain diagnostic code (ICD).

	NOTE:  This code is not to be used for acute or subacute pain management.
(H)       Supplies, Durable Medical Equipment (DME), Orthotics and Prostheses 
(5)        Payment for professional services associated with the fabrication and/or modification of orthotics, custom splints, adaptive equipment, and/or adaptation and programming of communication systems and devices shall be paid in accordance with the Colorado Medicare HCPCS Level II values RVP©.
(I)         Inpatient Hospital Facility Fees
(3)        Inpatient Facility Reimbursement:  
(c)        All other inpatient facilities are reimbursed as follows:
(1)        (MS-DRG Relative Wt x Specific hospital base rate x 155% 160%) + (reimbursement for all “Supply et al.”) + (trauma center activation allowance)
(J)         Scheduled Outpatient Surgery Facility Fees
(3)        Outpatient Surgery Facility Reimbursement: 
(c)        All other outpatient surgery facilities are reimbursed based on Exhibit 4 of this Rule 18.  Exhibit 4 lists Medicare’s Outpatient Hospital Ambulatory Prospective Payment Codes (APC) with the Division’s values for each APC code.  Grouper code 210, found in Exhibit 4, was DoWC created to reimburse RVP© spinal fusion codes not listed in Medicare's Revised January 2010 Update to reflect Affordable Care Act 05/18/2010- Addendum B [PDF, 961KB]  (Revised Addendum B) http://www.cms.gov/apps/ama/license.asp?file=/hospitaloutpatientpps/downloads/2010revisedwebjanuary_addb_05.17.10.zip  (last accessed June 8, 2010) Addendum B.
	The surgical procedure codes are classified by APC code in Medicare’s April 2009 Revised Addendum B.  This Addendum B should be used to determine the APC code payable under the Division’s Exhibit 4.  However, not every surgical code listed under Revised Addendum B warrants a separate facility fee.
	The April 2009 Revised Addendum B can be accessed at Medicare’s Hospital Outpatient PPS website.  
(1)        The highest valued APC code per Exhibit 4 plus 50% of any lesser-valued APC code values.
If an arthroscopic procedure is converted to an open procedure on the same joint, only the open procedure is payable.  If an arthroscopic procedure and open procedure are performed on different joints, the two procedures may be separately payable with anatomic modifiers.  
When reported in conjunction with other knee arthroscopy codes, any combination of surgical knee arthroscopies for removal of loose body, foreign body, and/or debridement/shaving of articular cartilage shall be paid only if performed in a different compartment of the knee; and
(3)        Diagnostic testing and preoperative labs may be reimbursed by applying the appropriate CF to the unit values for the specific CPT® code as listed in the RVP.
However, diagnostic testing and preoperative labs shall be reimbursed according to Exhibit #4 when it lists a dollar value greater than zero.  Other services with non-zero Exhibit #4 values, such as cardiac and dialysis procedures, shall also be reimbursed according to Exhibit #4.  Use Medicare’s Revised Aaddendum B to link Exhibit #4 APC Grouper numbers to CPT® codes. http://www.cms.hhs.gov/apps/ama/license.asp?file=/hospitaloutpatientpps/downloads/2009_April_Addendum_B_040109.zip (last accessed September 1, 2009.)
(d)        In rare cases, a reasonable facility fee may be paid when an outpatient surgical procedure poses a significant risk to the injured worker if performed in a lesser facility, even if the procedure:

•	Has a zero dollar value in Exhibit 4, and/or 
•	Cannot be assigned to an APC Grouper based on Medicare’s Revised Addendum B. 
Once the risk to the injured worker has been provided in writing and the payer has agreed or it is ordered that this procedure may occur in the facility, a reasonable dollar value shall be determined by using a similar procedure code (if the exact code cannot be used) that can be assigned under Exhibit 4 or under Medicare’s Revised Addendum B.  If a value does not exist in Exhibit 4, then the APC dollar value from Medicare’s Revised Addendum B with reductions for “Supply et al.” is multiplied by 160% 158%.   The services normally included in Exhibit 4 values shall be included in this reimbursement value, and the services allowed as additional reimbursement under Rule 18-6 (J)(3)(c)(2)-(5) would be allowed.
(K)        Outpatient Diagnostic Testing and Clinic Facility Fees
(c)        All other facilities:
(2)        No separate facility fee allowance for diagnostic testing.  Facility fees for diagnostic testing are considered part of the procedure’s technical component value except when there is a non-zero value listed in Exhibit 4 for the diagnostic test.  Outpatient diagnostic testing is reimbursed using the RVP© code unit value, except when there is a non-zero value listed in Exhibit 4, in which case that value is used.  Dyes and contrasts may be reimbursed according to Rule 18-6(H) at 80% of billed charges.
(M)       Outpatient Emergency Room Department (ERD) Facility Fees
(3)        ERD Reimbursement
(d)        Total maximum value for an ERD episode of care includes the sum of the following:
(1)        ERD reimbursement amount for “Level of Care” points:
ERD                                                                   Reimbursement
Level                                                                                               
1			$    160.00 240.00 
2			$    360.00 390.00
3			$    620.00 590.00
4			$    870.00 840.00
5			$ 1,640.00 1,540.00 
Critical Care		$ 1,640.00 1,540.00
(N)        Home Therapy
(1)        Home Infusion Therapy
(b)        Antibiotic Therapy:
	$105.00/day + Average Wholesale Price (AWP) (See Rule 18-6(O)(14))
(c)        Chemotherapy:
	$ 85.00/day + AWP (See Rule 18-6(O)(14))
(e)        Pain Management:         $ 95.00/day + AWP (See Rule 18-6(O)(14))
(f)         Fluid Replacement:        $ 70.00/day + AWP (See Rule 18-6(O)(14))
(g)        Multiple Therapies:
	Rate per day for highest cost therapy only + AWP (See Rule 18-6(O)(14)) for all drugs 
	Medication/Drug Restrictions - the payment for drugs may be based upon the AWP (See Rule 18-6(O)(14)) of the drug as determined through the use of industry publications such as the monthly Price Alert, First Databank, Inc.
(2)        Nursing Services
DoWC Z770     Skilled Nursing (LPN & RN)
$95.79 per hour 
There is a limit of 2 hours without prior authorization for payment (see Rule 16-9 and 16-10).
DoWC Z771     Certified Nurse Assistant (CNA):
$31.67 per hour for the first hour per trip to injured worker;
$  9.46 for each additional half hour.  Service must be at least 15 minutes to bill an additional half hour charge.
(4)        Mileage 
Travel allowances should be agreed upon with the payer and the mileage rate should not exceed $0.47 52  per mile, portal to portal.
DoWC code:      Z772  
(O)        Pharmacy Fees
(1)        AWP (See Rule 18-6(O)(14)) + $4.00
(7)        AWP (See Rule 18-6(O)(14)) for brand name and generic pharmaceuticals may be determined through the use of such monthly publications as Price Alert, First Databank, Inc., Red Book, Medispan.  In case of a dispute on AWP values, the parties should take the average of their referenced published values.
 (12)       Provider Reimbursement
Provider offices that prescribe and dispense medications from their office have a maximum allowance of AWP (See Rule 18-6(O)(14)) plus $4.00.
(14)	If average wholesale price (AWP) ceases, substitute Wholesale Acquisition Cost (WAC) + 20% for AWP everywhere it is found in this rule.
(Q)        Acupuncture 
(3)        Billing Codes:
(b)        Non-Physician evaluation services
(2)        LAc new patient visit:
            DoWC Z800     Maximum value $94.40 91.68 
(3)        LAc established patient visit:
            DoWC Z801     Maximum value $63.72 61.88 

Exhibit 1 Struck and Replaced
Exhibit #2 struck and Replaced
Exhibit #3 Strike Cap with corrections
Exhibit 3
Effective January 1, 2011 2010
Exhibit 4 Struck and Replaced
Exhibit 5 Strike Cap with corrections
Exhibit 5	
Effective January 1, 2011 2010	
Rural Health Facilities	
	
Akron Clinic	
82 Main	
Akron, CO  80720	
Telephone:  (970) 345-6336, Fax:  (970) 345-6576	
	
Arkansas Valley Family Practice, LLC	
2317 San Juan Avenue	
La Junta, CO  81050	
Telephone:  (719) 383-2325, Fax:  (719) 383-2327	
	
Button Family Practice	
715 South 9th Street 	
Cannon City, Co 81212 – Fremont County	
Telephone:  (719) 269-8820, Fax:  (719) 204-0230	
	
Colorado Plains Clinic – Wiggins	
226 Main Street	
Wiggins, Co 80654 – Morgan County	
Telephone:  (970) 483-7283	
	
Convenient Care Clinic	
403 Kendell Drive	
Lamar, CO  81052	
Telephone:  (719) 336-6767, Fax:  (719( 336-7217	
	
Fort Morgan Pediatric Clinic, PC	
1000 Lincoln Street, Ste. 202	
Fort Morgan, CO  80701	
Telephone:  (970) 542-9187, Fax:  (970) 867-9187	
	
Health Services Clinic	
1800 East 3rd Avenue	
Durango, CO  81301	
Telephone:  (970) 764-1790, Fax:  (970) 375-7927	
	
Holly Medical Clinic	
410 West Colorado	
Holly, CO  81047	
Telephone:  (719) 537-6642, Fax:  (719) 537-0637	
	
La Jara Medical Clinic	
509 Main Street	
La Jara, CO  81140	
Telephone:  (719) 274-6000,. Fax:  (719) 274-4111	
	
Lamar Medical Clinic	
403 Kendall Drive	
Lamar, CO  81052	
Telephone:  (719) 336-6767; Fax:  (719) 336-7217	
	
Pagosa Mountain Clinic	
95 South Pagosa Blvd.	
Pagosa Springs, CO  81147	
Telephone:  (970) 731-3700, Fax:  (970) 731-3707	
	
Surface Creek Family Practice	
255 SWw 8th Ave	
Cedaredge, Co 81413 - Delta County	
Telephone: (970) 856-3146, Fax: (970) 856-4385	
	
United Medical Center Of Berthoud	
549 Mountain Avenue	
Berthoud, Co 80513 - Larimer County	
Telephone: (970) 532-4644, Fax: (970) 532-0608	
	
Walsh Medical Clinic	
137 Kansas Street	
Walsh, CO 81090	
Telephone:  (719) 324-5253, Fax:  (719) 324-5621	

Exhibit 6 Struck and Replaced