Medicare AdvantageCoverageHigh impact
Ambetter Health Billing Code Update for various HCPC H Codes: Effective 01/01/2027
Ambetter·IA · Psychiatry, Family Medicine, Internal Medicine·Claims & Billing
Effective date
Jan 1, 2027
We identified it
Aug 26, 2026
Summary
Effective 01/01/2027, Ambetter Health is discontinuing coverage for 52 HCPCS H codes related to alcohol/drug treatment, behavioral health services, and mental health support. Simultaneously, H0006 (Alcohol/drug service, case management) will become newly covered. The billing team must immediately identify affected claims in the system and implement denial protocols for non-covered codes starting January 1, 2027.
Action Required
By 12/15/2026: Billing team must update billing system to flag and deny claims using 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 when submitted to Ambetter Health plans. Configure system to allow H0006 for billing. Notify providers and clinical staff that behavioral health and substance abuse treatment codes (except case management) will no longer be reimbursable by Ambetter effective 01/01/2027. Audit current contracts and pending claims to identify affected services. Update superbills and EMR templates to reflect coverage changes. Claims submitted with non-covered H codes after 01/01/2027 will be denied by Ambetter.