Medicare AdvantageCoverageHigh impact
Ambetter from Coordinated Care Corporation Billing Code Update for various HCPC H Codes: Effective 01/01/2027
Ambetter·WA · Psychiatry·Claims & Billing
Effective date
Jan 1, 2027
We identified it
Aug 26, 2026
Summary
Effective January 1, 2027, Ambetter from Coordinated Care Corporation will discontinue coverage for 42 HCPCS H codes (primarily behavioral health and social services codes) while simultaneously adding coverage for H0006. Billing teams must identify all claims currently using the discontinued codes and transition to alternative coding or request prior authorization to determine covered alternatives.
Action Required
By December 31, 2026: Billing team must audit all current and pending claims using the 42 discontinued H codes (H0003-H0047, H1011, H2001-H2033, excluding H0006) to Ambetter from Coordinated Care Corporation plans. Update billing system edits to flag or block these codes for Ambetter CCC effective 01/01/2027. Contact provider relations representative to identify approved alternative codes or billing procedures for behavioral health and social services currently billed under these codes. Update encounter forms and provider documentation templates to reflect coverage changes. Communicate changes to all clinical staff submitting claims to this payer. Beginning 01/01/2027, claims submitted with discontinued codes will be denied. Simultaneously, ensure H0006 is configured in the billing system as a covered code for Ambetter CCC effective that date.