HCPCS H0002 is officially defined as "Behavioral health screening to determine eligibility for admission to treatment program." HCPCS H0002 is referenced in 12 tracked payer policy changes from Sentara Health Plans, Mississippi Medicaid (DOM), and 6 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS H0002 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Starting January 1, 2027, Sentara Health Plans will require prior authorization for a long list of codes on Virginia commercial plans, including self-funded (ASO) plans, and for code 88380 on commercial, Medicaid and Medicare products, plus code 22860 on Medicare products. Sentara will also stop covering a separate list of codes on Virginia commercial and self-funded plans.
Sentara Health Plans relaxed prior authorization requirements for 499 codes for commercial products offered in Virginia, covering categories such as medical and surgical supplies, cardiovascular procedures, proprietary laboratory analyses and outpatient PPS codes. Effective February 1, 2026, commercial prior authorization is required for a further set of codes, several psychological testing codes now require authorization only after the listed hour limits, and several commercial codes, including 99070, A9286, G0330 and S9152, are not covered. Self-funded commercial products had separate prior authorization and not-covered code lists effective February 1, 2026, and Medicaid changes took effect October 1, 2025 and December 1, 2025.
Mississippi Medicaid has updated reimbursement rates for Home and Community-Based Services (HCBS) across multiple waiver programs, effective January 1, 2026. This affects rates for services including assisted living, day services, job development, respite care, personal care, and various support services under AL, 1915(i) CSP, E&D, IL, ID/DD, and TBI/SCI waiver programs.
Michigan Medicaid now requires limited licensed master's level behavioral health providers, including Temporary Limited Licensed Psychologists, Limited Licensed Counselors, Educational Limited Licensed Marriage and Family Therapists and Limited Licensed Master's level Social Workers, to be Medicaid-enrolled and uniquely identified on claims, effective September 1, 2026. For dates of service on and after September 1, 2026, these providers no longer report services under their supervising provider's NPI, and reimbursement goes to their associated billing provider because they are not eligible for direct reimbursement by Medicaid. For fee-for-service beneficiaries, a LOCUS or MichiCANS Screener completion is reported under HCPCS H0031 (LOCUS) or H0002 (MichiCANS Screener) for dates of service on and after September 1, 2026.
Effective for dates of service on or after Dec. 1, 2025, South Carolina Medicaid updated the reimbursement methodology and rates for Medicaid State Plan services rendered by rehabilitative behavioral health (RBHS) providers, Office of Substance Use Services-affiliated organizations and licensed independent practitioners (LIPs). The Department of Alcohol and Other Drug Abuse Services Fee Schedule will be renamed to align with the Office of Substance Use Services. The December 17, 2025 update also changed H0032 from a 15-minute timed unit to a 30-minute encounter for RBHS providers, changed H0002 from a timed unit to an untimed encounter, and corrected the H0038 peer support rate to $14.48 per unit.
Michigan Medicaid bulletin MMP 26-01 sets standardized mental health assessment requirements for mental health providers who serve enrollees in a Medicaid Health Plan (MHP), effective for dates of service on and after October 1, 2025. Providers use the MichiCANS Screener for enrollees from birth to age 18 and the Level of Care Utilization System (LOCUS) for enrollees age 18 and older, with reassessment every 12 months or upon change in condition. Standardized assessments alone cannot be used to determine, limit or restrict the amount, scope or duration of services, and the assessment tools are for MHP enrollees while PIHP requirements remain unchanged. Because October 1, 2025 has passed as of the analysis date of 2026-11-05, this is and current applicability should be checked before acting.
Effective for dates of service on and after August 11, 2025, schools that provide school-based services can submit claims to ForwardHealth for an expanded set of procedure codes. The new codes cover psychological, counseling, social work, and mental and behavioral health services, therapy and audiology services, nursing and physician services, and dental services. Modifiers are no longer required on school-based services claims for those dates of service, although allowable modifiers are still accepted, and other claims submission requirements have not changed.
AHCCCS has corrected previous guidance and now allows Counseling Facility providers to bill T1016 (case management services) within their scope of practice. This reverses an April 29, 2025 notice that previously indicated T1016 was not covered for counseling facility providers.
Mental health and substance abuse screening, preventive mental health counseling and substance abuse intervention is a new benefit for pregnant women enrolled in BadgerCare Plus and Wisconsin Medicaid. The screening identifies women at risk for mental health or substance abuse problems, and brief counseling or intervention is provided to women identified as at risk. These services require no prior authorization, are not subject to copayment, and do not count toward other service limitations or prior authorization thresholds.
A provider licensed with ADHS solely as a counseling facility may bill only from six HCPCS codes: H0001 alcohol and/or drug assessment, H0002 behavioral health screening to determine eligibility, H0004 behavioral health counseling and therapy per 15 minutes, H0023 behavioral health outreach service, H0031 mental health assessment by a non-physician, and H2011 crisis intervention service per 15 minutes. Claims for services outside those codes will be denied. Inpatient claims with an admission date equal to the discharge date are paid using the AHCCCS Outpatient Fee Schedule methodology, and a replacement claim is required for processing.
BCBSAZ covers telehealth only as the member's benefit plan provides. Under the BlueCare Anywhere benefit, telehealth is covered when the Telehealth Services Administrator provides the service and determines the condition is appropriate, for a medical, therapy or psychiatry consultation. Under the in-network telehealth benefit, a service is covered when it would be covered in person and can be provided effectively by telehealth, through audio-visual services or limited audio-only services, and out-of-network non-emergency telehealth is not covered. The most recent review, dated 07/29/26, made no revisions.
This is a policy review and restatement of Aetna's existing Clinical Policy Bulletin 0730 for home behavioral healthcare services, last reviewed on 2026-10-21. The policy defines medical necessity criteria for skilled behavioral health services delivered in the home as an alternative to hospitalization or residential treatment. No changes to coverage, billing codes, or requirements are indicated; this appears to be a routine policy maintenance review.
Watch H0002
Get one email when a payer policy names H0002, a payer adds or drops it from a prior auth list, or Medicare changes its NCCI pairs, unit limit, payment or coverage articles.
See every payer rule for H0002
Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for H0002 in one place.
Get alerts for changes like this
Save a search and get email alerts when a new policy change matches your filters: daily or weekly, your choice, on every plan.