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Ambetter of Alabama Billing Code Update for various HCPC H Codes: Effective 01/01/2027

Ambetter·AL · Psychiatry·Claims & Billing
Effective date
Jan 1, 2027
We identified it
Aug 26, 2026
Days to comply
125 days

Summary

Effective January 1, 2027, Ambetter of Alabama will discontinue coverage for 45 HCPCS H codes (primarily behavioral health and support services codes) while adding coverage for H0006. Billing teams must immediately identify affected claims and update billing software to prevent denials for non-covered codes after the effective date.

Action Required

Before Jan 1, 2027
By December 15, 2026: Billing team must complete the following: (1) Update billing software to flag H0003, H0004, H0005, H0007, H0008, H0009, H0010, H0011, H0012, H0013, H0014, H0016, H0019, H0021, H0024, H0026, H0027, H0028, H0029, H0030, H0034, H0037, H0039, H0040, H0041, H0042, H0043, H0044, H0045, H0046, H0047, H1011, H2001, H2010, H2011, H2012, H2013, H2015, H2016, H2018, H2021, H2022, H2028, H2029, H2030, H2031, H2032, and H2033 as non-covered effective 01/01/2027 for Ambetter of Alabama; (2) Configure system to accept H0006 for coverage beginning 01/01/2027; (3) Audit current claim queue for any pending claims using discontinued codes and contact Ambetter for guidance on reclassification or appeal; (4) Notify all providers and clinical staff that behavioral health and support services using these H codes will no longer be billable to Ambetter of Alabama after 12/31/2026; (5) Establish process to identify alternative billable codes or obtain patient responsibility documentation. Claims submitted after 01/01/2027 using discontinued codes will be denied, resulting in patient balance liability.

Affected Billing Codes

H0003
H0004
H0005
H0007
H0008
H0009
H0010
H0011
H0012
H0013
H0014
H0016
H0019
H0021
H0024
H0026
H0027
H0028
H0029
H0030
H0034
H0037
H0039
H0040
H0041
H0042
H0043
H0044
H0045
H0046
H0047
H1011
H2001
H2010
H2011
H2012
H2013
H2015
H2016
H2018
H2021
H2022
H2028
H2029
H2030
H2031
H2032
H2033
H0006