HCPCS H0010 is officially defined as "Alcohol and/or drug services; sub-acute detoxification (residential addiction program inpatient)." HCPCS H0010 is referenced in 34 tracked payer policy changes from Ambetter, Anthem BCBS, and 5 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS H0010 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.
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 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.
Effective October 1, 2026, Anthem Blue Cross and Blue Shield will require prior authorization (PA) for select substance use disorder (SUD) services in Ohio Medicaid and MyCare Ohio plans. New PA thresholds apply: SUD Intensive Outpatient Program (IOP) requires PA after 30 days per calendar year, and Acute Detoxification/Withdrawal Management requires PA after 7 days per episode of care. Billing teams must implement these requirements in their authorization workflows and submission processes.
Effective July 1, 2026, CareSource Ohio Next Generation MyCare & Medicaid is implementing new service frequency thresholds for behavioral health services. Prior authorization will be required once members exceed specified unit/day limits for withdrawal management, intensive outpatient programs, psychiatric support, and therapeutic services. Billing teams must track member utilization across all providers and obtain prior auth before services exceed thresholds to avoid claim denials.
Effective January 1, 2026, providers billing residential substance use disorder treatment for Tufts Health RITogether members must switch from UB-04 forms with POS code 21 to CMS-1500 forms with POS code 55. Claims submitted using the old format will be denied.
Indiana Medicaid is reminding providers that specific services (individual/group therapy, case management, drug testing, etc.) are included in the per diem rates for residential SUD treatment codes H2034 and H0010. These bundled services cannot be billed separately, and third-party providers performing included services should not bill Medicaid to avoid double billing.
Effective July 1, 2024, Premera HMO medical necessity criteria were added or updated for several drugs, including Repatha (evolocumab), Praluent (alirocumab), Leqvio (inclisiran), Nexletol and Nexlizet, and Evkeeza (evinacumab-dgnb) for hypercholesterolemia, and the reauthorization requirement for continued use of a maximum tolerated statin was removed for Evkeeza, Juxtapid, Leqvio, Nexletol, Nexlizet, Praluent and Repatha. Effective October 20, 2024, Carelon Medical Benefits Management clinical appropriateness guidelines for radiology, cardiology, genetic testing, radiation oncology and sleep were updated, including added indications for MRI and amyloid beta PET imaging in Alzheimer disease for patients considering or receiving lecanemab. Effective October 8, 2024, surgical treatment of femoral acetabular impingement is considered medically necessary when criteria are met.
Effective August 2, 2024, the Premera HMO C3 and C5 Complement Inhibitors policy (5.01.571) is a new policy in which the confirmed granulocyte clone size is updated to 15% or greater for Soliris (eculizumab), Ultomiris (ravulizumab-cwvz), and Empaveli (pegcetacoplan) for paroxysmal nocturnal hemoglobinuria (PNH). Effective October 20, 2024, Carelon Medical Benefits Management clinical appropriateness guidelines for radiology, cardiology, genetic testing, radiation oncology and sleep were updated, including added indications for MRI and amyloid beta PET imaging in Alzheimer disease for patients considering or receiving lecanemab. Effective October 8, 2024, surgical treatment of femoral acetabular impingement is considered medically necessary when criteria are met.
New Jersey Medicaid confirms that billing procedures for Substance Abuse Initiative (SAI) providers have NOT changed for Short-Term Residential, Long-Term Residential, and Residential Withdrawal Management services. Providers should continue using existing SAI procedure codes despite a July 2018 newsletter announcing new coverage.
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