ExchangeCoverageHigh impact
Ambetter from Buckeye Health Plan Billing Code Update for various HCPC H Codes: Effective 01/01/2027
Ambetter·OH · Psychiatry·Claims & Billing
Effective date
Jan 1, 2027
We identified it
Aug 26, 2026
Summary
Effective January 1, 2027, Ambetter from Buckeye Health Plan will discontinue coverage for 45 HCPCS H codes commonly used for behavioral health and community support services. Simultaneously, H0006 coverage will begin. The practice must identify all affected claims and implement billing workflow changes to avoid denials.
Action Required
By December 1, 2026: (1) Billing team must audit all current claims and service contracts using H codes H0003-H0047, H1011, and H2001-H2033 for Ambetter from Buckeye Health Plan members in Ohio. (2) Update billing system to deny or route for manual review any claims submitted on or after 01/01/2027 using the 45 discontinued H codes for this payer. (3) Add alert in billing software to flag H0006 as NOW COVERED beginning 01/01/2027 (update from current non-coverage status if applicable). (4) Notify providers and clinical staff of coverage discontinuation for affected behavioral health and community support services via written alert and updated fee schedule. (5) Establish process to identify alternative billing codes or obtain prior authorization for patient care previously billed with discontinued codes. Failure to implement these changes will result in claim denials and revenue loss for services rendered to Ambetter Buckeye members.