Medicare AdvantageCoverageHigh impact
Ambetter of North Carolina Inc. Billing Code Update for various HCPC H Codes: Effective 01/01/2027
Ambetter·NC · Psychiatry, General Practice·Claims & Billing
Effective date
Jan 1, 2027
We identified it
Aug 26, 2026
Summary
Effective January 1, 2027, Ambetter of North Carolina Inc. will discontinue coverage for 45 HCPCS H codes (primarily behavioral health and substance abuse treatment services) while adding coverage for H0006. Billing teams must immediately identify affected claims and update billing systems to prevent denials for these services beginning 2027.
Action Required
By December 15, 2026: Billing team must update billing software and claims processing rules to reflect Ambetter of North Carolina Inc. coverage changes. ACTIONS: (1) Configure system to reject or flag claims for H0003-H0005, H0007-H0014, H0016, H0019, H0021, H0024, H0026-H0030, H0034, H0037, H0039-H0047, H1011, H2001, H2010-H2013, H2015-H2016, H2018, H2021-H2022, H2028-H2033 when submitted to Ambetter NC effective 01/01/2027; (2) Activate H0006 as covered code for Ambetter NC in billing system; (3) Update provider encounter templates and billing worksheets to alert staff of non-covered codes; (4) Review current patient roster for active Ambetter NC members to identify behavioral health/substance abuse service lines that will be affected. Behavioral health and behavioral therapy providers must identify alternative billing codes or referral pathways for affected services. Failure to update systems will result in claim denials and revenue loss for behavioral health services beginning January 1, 2027.