ExchangeCoverageHigh impact
Ambetter from Absolute Total Care Billing Code Update for various HCPC H Codes: Effective 01/01/2027
Ambetter·SC · Psychiatry, General Practice·Claims & Billing
Effective date
Jan 1, 2027
We identified it
Aug 26, 2026
Summary
Effective January 1, 2027, Ambetter from Absolute Total Care will discontinue coverage for 45 HCPCS H codes (primarily behavioral health and substance abuse treatment services) while adding coverage for H0006. Billing teams must identify all claims using discontinued codes and transition to alternative codes or obtain patient verification of coverage changes.
Action Required
By December 15, 2026: Billing team must complete the following: (1) Audit all current Ambetter from Absolute Total Care claims to identify use of the 45 discontinued H codes listed above; (2) Update billing software to flag or deny claims using codes H0003-H0005, H0007-H0014, H0016, H0019, H0021, H0024, H0026-H0047, H1011, and H2001-H2033 for Ambetter from Absolute Total Care plans effective 01/01/2027; (3) Identify alternative HCPCS codes for discontinued services and establish replacement code mapping in the billing system; (4) Confirm H0006 is enabled as a covered code in billing software starting 01/01/2027; (5) Notify all providers and clinical staff that behavioral health and substance abuse services billed under discontinued codes will be denied by Ambetter; (6) Contact Provider Relations Representative for guidance on code alternatives and coverage transitions. Failure to update billing rules will result in claim denials and revenue loss. This change requires immediate vendor coordination if using third-party billing software.