CommercialBilling CodesHigh impact
26-084 Commercial Plans Will No Longer Accept Medicare-Specific G-Codes Starting April 1, 2026
Health Net·CA·Reimbursement
Effective date
Apr 1, 2026
We identified it
Jun 20, 2026
Summary
Starting April 1, 2026, Commercial plans (Ambetter HMO/PPO and Employer Group plans) will no longer accept Medicare-specific G-codes G0402, G0438, and G0439. Providers must use standard preventive CPT codes (99381-99387 for new patients, 99391-99397 for established patients) when billing Commercial plan members for preventive visits.
Action Required
Before April 1, 2026: Billing team must update billing system to automatically use standard preventive CPT codes (99381-99387 for new patients, 99391-99397 for established patients) instead of G0402, G0438, and G0439 for all Commercial plan members. Update encounter forms and EMR templates to reflect correct coding. Verify eligibility and benefits prior to visits to confirm plan type. Claims using Medicare G-codes for Commercial members will be denied after the effective date.