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PAYER POLICY CHANGES

H0035 Insurance Policy Changes

HCPCS H0035 is officially defined as "Mental health partial hospitalization, treatment, less than 24 hours." HCPCS H0035 is referenced in 18 tracked payer policy changes from Utah Medicaid, Ambetter, and 6 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS H0035 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

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REFERENCE DATA

Payers with rules14
Payers requiring prior auth14
  • Blue Shield of California · Effective November 1, 2026

    Prior authorization required

    Prior Authorization List for Blue Shield Medicare

  • Anthem BCBS · Effective October 19, 2026

    Prior authorization required

    Anthem local precertification/prior authorization list (Colorado | Anthem Blue Cross and Blue Shield | Commercial)

  • BCBS Michigan · Effective October 13, 2026

    Prior authorization required in some cases

    BCBSM and BCN procedure codes for which providers must request prior authorization (commercial lines)

FREQUENTLY ASKED QUESTIONS

Does Ambetter require prior authorization for H0035?

Ambetter lists H0035 on Ambetter from Arizona Complete Health CMS-0057-F prior authorization requirements for exchange plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does AmeriHealth Caritas require prior authorization for H0035?

AmeriHealth Caritas lists H0035 on AmeriHealth Caritas Louisiana prior authorization service list for medicaid managed plans. Verify with the payer before scheduling.

Does Anthem BCBS require prior authorization for H0035?

Anthem BCBS lists H0035 on Anthem local precertification/prior authorization list (Colorado | Anthem Blue Cross and Blue Shield | Commercial) for commercial plans (list dated October 19, 2026). Verify with the payer before scheduling.

Does Arizona Complete Health require prior authorization for H0035?

Arizona Complete Health lists H0035 on Arizona Complete Health CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does BCBS Arizona require prior authorization for H0035?

BCBS Arizona lists H0035 on AZ Blue Standard Prior Authorization Requirements Code List (Updated 10/01/2026) for commercial plans (list dated October 1, 2026). Verify with the payer before scheduling.

What insurance policy changes affect HCPCS H0035?

There are 18 tracked policy changes affecting HCPCS H0035, including updates from Utah Medicaid, Ambetter, Colorado Medicaid. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for HCPCS H0035?

Payers that have issued tracked updates for HCPCS H0035 include: Utah Medicaid, Ambetter, Colorado Medicaid, Nevada Medicaid, CareSource, Health Net, Aetna Better Health of Virginia, Premera Blue Cross.

How do I get notified when HCPCS H0035 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to HCPCS H0035. You will get an email when new policy changes reference this code: daily or weekly, your choice, on every plan.

Why do payers change policies for HCPCS H0035?

Payers revise policies for individual billing codes to align with updated clinical guidelines, CMS rule changes, fraud and abuse prevention measures, or network cost-management goals. Changes can affect medical necessity criteria, place-of-service restrictions, bundling rules, or whether a code requires prior authorization.

See every payer rule for H0035

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for H0035 in one place.

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