HCPCS H0005 is officially defined as "Alcohol and/or drug services; group counseling by a clinician." HCPCS H0005 is referenced in 39 tracked payer policy changes from Ambetter, Healthfirst, and 7 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS H0005 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Effective January 1, 2027, Ambetter Health of Delaware will stop covering 45 HCPCS H codes (H0003–H0047, H1011, H2001–H2033) and will begin covering HCPCS code H0006. The practice must stop billing the discontinued codes to Ambetter Delaware members and update charge entry and claim submission processes to reflect coverage changes.
Effective 01/01/2027, Ambetter Health will discontinue coverage for 45 HCPC H codes (primarily behavioral health and community support services) and will begin covering HCPC code H0006. Billing teams must update coding practices and prior authorization workflows to reflect these coverage changes.
Ambetter of North Carolina will stop covering a list of HCPCS H codes starting January 1, 2027, and will cover H0006 from that date. Earlier changes are already effective: CPT 80320-80377 drug testing codes were no longer reimbursable from October 1, 2026, and the prior authorization changes effective October 1, 2026 took effect. The newsletter also covers surrogacy diagnosis codes Z33.3 and Z31.7, behavioral health type of bill guidance, and clinical policy updates effective 11/1/2026.
Effective November 1, 2026, Healthfirst bundles G2211 into the E/M service for HARP, Essential Plan and Qualified Health Plan members, and treats G0545, the listed counseling, screening and vision codes, and prolonged service codes 99415 through 99418 as inclusive to the associated E/M or preventive service for Medicaid Managed Care, Child Health Plus, HARP, Essential Plan and Qualified Health Plan members. Effective January 1, 2027, G0545 and the listed counseling, screening and vision codes are not separately reimbursable with an E/M or preventive medicine service for Medicare Advantage and CompleteCare (MAP) members, and CPT 99415 through 99418 are non-covered for those plans. Claims with G2211, G2212 or G0545 billed with an E/M service appended with modifier 25 will be denied, and G2211 is not separately reimbursable for Healthfirst Medicaid members age 21 and older.
Ambetter of North Carolina's June 2026 provider newsletter says it will stop covering 48 HCPCS H codes beginning January 1, 2027, and will cover H0006 from that date. The newsletter also says drug testing codes G0482 and G0483 are no longer reimbursable under the drugs-of-abuse policy (no date is given), and it lists clinical policy revisions effective August 15, 2026 and a reminder to verify member eligibility by paid-through dates.
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.
Effective January 1, 2027, Ambetter of Illinois will discontinue coverage for 46 HCPCS H codes (behavioral health and social services codes) while adding coverage for H0006. Billing teams must identify all claims currently using the non-covered codes and implement workflow changes to prevent claim denials after the effective date.
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.
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.
Effective January 1, 2027, Ambetter of Tennessee will discontinue coverage for 46 HCPCS H codes (primarily behavioral health and social services codes) while adding coverage for H0006. The billing team must identify all claims currently using the non-covered codes and transition to alternative billing codes or obtain clarification on approved alternatives before the effective date.
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.
Effective January 1, 2027, Ambetter of Oklahoma will discontinue coverage for 46 HCPCS H codes commonly used for behavioral health, substance abuse treatment, and related services. Simultaneously, H0006 coverage begins on the same date. The billing team must identify all affected claims and establish processes to deny or redirect these codes for Ambetter Oklahoma members.
Effective January 1, 2027, Ambetter from SilverSummit Healthplan will discontinue coverage for 45 HCPCS H codes (primarily behavioral health and support services) while adding coverage for H0006. Billing teams must identify all claims using the discontinued codes and implement alternative billing strategies or obtain patient financial responsibility agreements.
Effective January 1, 2027, Ambetter from WellCare of New Jersey will discontinue coverage for 45 HCPCS H codes (behavioral health and substance abuse treatment services) while adding coverage for H0006. Billing teams must identify all claims using the discontinued codes and implement alternative billing strategies or prior authorization processes before the effective date.
Effective January 1, 2027, Ambetter of North Carolina Inc. will discontinue coverage for 45 HCPCS H codes (primarily behavioral health and substance abuse treatment services) while adding coverage for H0006. Billing teams must immediately identify affected claims and update billing systems to prevent denials for these services beginning 2027.
Effective 01/01/2027, Ambetter from Magnolia Health will discontinue coverage for 45 HCPCS H codes (behavioral health and substance abuse treatment services) while adding coverage for H0006. Billing teams must immediately identify affected services, update claim submission logic, and prepare providers for coverage gaps to avoid claim denials.
Effective January 1, 2027, Ambetter from Home State Health will discontinue coverage for 45 HCPCS H codes (behavioral health and social services codes) while adding coverage for H0006. Billing teams must identify all claims currently using the non-covered codes and develop transition plans, as continued billing of these codes will result in denials.
Effective January 1, 2027, Ambetter from Meridian will no longer cover 45 HCPCS H codes (behavioral health and social services codes), while H0006 will begin coverage on that same date. Billing teams must identify all claims using the discontinued codes and implement alternative billing strategies or have claims denied.
Effective January 1, 2027, Ambetter from Louisiana Healthcare Connections will discontinue coverage for 45 HCPCS H codes (behavioral health and social services) while adding coverage for H0006. Billing teams must identify affected claims, update system edits, and establish alternative coding or prior authorization protocols before the effective date.
Effective January 1, 2027, Ambetter from WellCare of Kentucky will discontinue coverage for 46 HCPCS H codes (behavioral health and social services codes), while simultaneously activating coverage for H0006. Billing teams must identify all claims currently using the discontinued codes and establish alternative billing strategies or obtain prior authorization requirements before the effective date.
Effective January 1, 2027, Ambetter from Peach State Health Plan will discontinue coverage for 45 HCPC H codes (H0003-H0047, H1011, H2001-H2033) commonly used for behavioral health, substance abuse treatment, and support services. Simultaneously, H0006 coverage will be newly activated. Practices must identify affected claims, update billing systems, and establish alternative coding or coverage verification processes before the effective date.
Effective January 1, 2027, Ambetter Health will discontinue coverage for 45 HCPCS H codes (primarily behavioral health and substance abuse treatment codes) while simultaneously adding coverage for H0006. Billing teams must immediately identify affected services, audit current patient encounters, and prepare to transition claims to alternative coding or halt billing for these services by the effective date.
Effective January 1, 2027, Ambetter from Arizona Complete Health will discontinue coverage for 45 HCPCS H codes (primarily behavioral health and social services codes) while adding coverage for H0006. Billing teams must identify all claims using the discontinued codes and implement alternative billing strategies to avoid claim denials.
Effective January 1, 2027, Ambetter from Arkansas Health & Wellness 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 the discontinued codes and establish alternative coding or prior authorization strategies to avoid claim denials.
Effective January 1, 2027, Ambetter of Alabama will discontinue coverage for 45 HCPCS H codes (primarily behavioral health and support services codes) while adding coverage for H0006. Billing teams must immediately identify affected claims and update billing software to prevent denials for non-covered codes after the effective date.
Effective January 1, 2027, Ambetter Health will discontinue coverage for 45 HCPCS H codes commonly used for behavioral health, substance abuse treatment, and related services. Simultaneously, HCPCS code H0006 will become newly covered. Billing teams must immediately identify affected claims and update billing logic to prevent denials.
Ambetter from Superior HealthPlan is discontinuing coverage for 46 HCPCS H codes effective January 1, 2027, while adding coverage for H0006. Billing teams must identify claims currently using discontinued codes and establish alternative billing strategies or prior authorization workflows before the effective date.
Effective January 1, 2027, Ambetter from Sunflower Health Plan 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 currently using discontinued codes and establish alternative billing strategies or obtain patient notification protocols before the effective date.
Published June 22, 2026: Ambetter Health announced that 46 listed HCPCS H codes will no longer be covered beginning January 1, 2027, while HCPCS H0006 will become covered on that same date. Billing teams should identify claims and scheduled services using the listed H codes for January 2027 dates of service and prepare charge entry and provider notification accordingly.
Health First Colorado added daily limits and same day billing limits for a list of behavioral health and supportive service codes, active since Aug. 1, 2026 for some codes and effective Oct. 1, 2026 for others, and Regional Accountable Entities (RAEs) enforce them. Claims with dates of service of Aug. 1, 2026 or later deny if an updated provider license is not on file, and a recovery residence policy takes effect Oct. 1, 2026. This bulletin also covers a number of other changes with dates from Aug. 31, 2026 through Jan. 1, 2027, including the APR-DRG Version 42 update that moved to Jan. 1, 2027.
Nevada Medicaid clarifies that members receiving residential substance use treatment at ASAM levels 3.1, 3.5, or 3.7 (PT 93 providers) cannot simultaneously bill outpatient SUD services on the same date of service, except on admission and discharge dates. A specific list of outpatient codes is prohibited from being billed concurrently with residential SUD codes to eliminate duplicative billing.
Effective August 17, 2026, Narcotic Treatment Services (NTS) providers in Wisconsin must use Place of Service (POS) code 15 (Mobile Unit) when billing for services delivered via mobile treatment vehicles. This is a new coding requirement for mobile opioid treatment programs that extend brick-and-mortar sites. All existing coverage policy requirements (regulatory, documentation, staffing, confidentiality) apply to mobile unit services.
Effective December 1, 2025, ForwardHealth adds continuing care coverage for members discharged from DHS 75-certified outpatient substance use disorder treatment programs and requires the new U2 modifier on continuing care claims. It also reimburses outpatient mental health services as a concurrent service with residential SUD treatment, allows medication management through Comprehensive Community Services during residential SUD treatment, and covers point-of-care drug testing within the Intensive Outpatient Program, which must be billed with HCPCS code 80305.
CareSource Ohio Medicaid is reminding Community Behavioral Health providers (group types 84/95) of critical billing rules to prevent denials. Key restrictions include: mental health and substance use disorder codes must be billed under correct specialty NPIs; H0005 is limited to 4 units when billed with H0015 on the same date; and four specific group therapy codes are limited to 4 units (1 hour) per day when billed together unless prior authorized.
ForwardHealth (Wisconsin Medicaid) expands behavioral health treatment options effective December 1, 2025, adding continuing care coverage for discharged SUD patients and allowing concurrent outpatient mental health services with residential SUD treatment. A new U2 modifier is required for billing continuing care services.
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.
Louisiana's School-Based Medicaid Program (SBMP) is adding two new behavioral health procedure codes effective August 29, 2025: H0004 for behavioral health counseling/therapy (per 15 minutes) at $10.00 and H0005 for alcohol/drug group counseling at $10.00. This expansion is part of SBMP's commitment to provide substance abuse coverage services to eligible students.
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.
Relying solely on billing statements, member notification, or collection agencies is not effective, so providers must take appropriate and reasonable action to identify Health First Colorado eligibility within 365 days. Fee-for-service behavioral health codes were rebalanced to 80 to 100 percent of the Medicare benchmark effective April 1, 2021, and Medicaid prescribers of controlled substances must query the Colorado Prescription Drug Monitoring Program before prescribing to Medicaid members effective October 1, 2021, except in the listed situations. Physician-administered drugs on the listed set will require prior authorization no earlier than October 1, 2021.
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