ExchangeCoverageHigh impact
Ambetter from SilverSummit Healthplan Billing Code Update for various HCPC H Codes: Effective 01/01/2027
Ambetter·NV · Psychiatry·Claims & Billing
Effective date
Jan 1, 2027
We identified it
Aug 26, 2026
Summary
Effective January 1, 2027, Ambetter from SilverSummit Healthplan will discontinue coverage for 45 HCPCS H codes (primarily behavioral health and support services) while adding coverage for H0006. Billing teams must identify all claims using the discontinued codes and implement alternative billing strategies or obtain patient financial responsibility agreements.
Action Required
By December 31, 2026: Billing team must audit current claim submission patterns to identify which of the 45 discontinued H codes are regularly billed to Ambetter from SilverSummit Healthplan members. Update billing system to flag these codes (H0003, H0004, H0005, H0007-H0014, H0016, H0019, H0021, H0024, H0026-H0030, H0034, H0037, H0039-H0047, H1011, H2001, H2010-H2013, H2015-H2016, H2018, H2021-H2022, H2028-H2033) for this payer effective 01/01/2027 to prevent claim denials. Identify alternative codes if available or prepare patient financial responsibility forms. Confirm that H0006 is enabled in billing software for continued coverage. Clinical and billing leadership should communicate with Ambetter about available alternative services or codes. Failure to implement these changes will result in claim denials and potential patient billing complications.