Medicare AdvantageCoverageHigh impact
Ambetter from Home State Health Billing Code Update for various HCPC H Codes: Effective 01/01/2027
Ambetter·MO · Psychiatry·Claims & Billing
Effective date
Jan 1, 2027
We identified it
Aug 26, 2026
Summary
Effective January 1, 2027, Ambetter from Home State Health will discontinue coverage for 45 HCPCS H codes (behavioral health and social services codes) while adding coverage for H0006. Billing teams must identify all claims currently using the non-covered codes and develop transition plans, as continued billing of these codes will result in denials.
Action Required
By December 31, 2026: Billing team must complete the following: (1) Audit all active Ambetter from Home State Health encounters and claims to identify usage of H codes H0003–H0005, H0007–H0014, H0016, H0019, H0021, H0024, H0026–H0030, H0034, H0037, H0039–H0047, and H1011–H2033 (excluding H0006); (2) Update billing software to block submission of these 45 non-covered codes for Ambetter from Home State Health members starting 01/01/2027; (3) Review clinical workflows with providers and behavioral health staff to identify alternative coding or service delivery options for affected services; (4) Update encounter forms and templates to flag H0006 as the only covered H code effective 01/01/2027; (5) Communicate changes to all providers, clinical staff, and front desk personnel. Claims submitted with non-covered H codes after the effective date will be denied by Ambetter from Home State Health.