HCPCS H2011 is officially defined as "Crisis intervention service, per 15 minutes." HCPCS H2011 is referenced in 44 tracked payer policy changes from Ambetter, Nebraska Medicaid, and 12 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS H2011 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.
Nebraska Medicaid is discontinuing coverage for Crisis Stabilization code S9484 with 52 modifier effective July 1, 2026, and clarifying billing limits and same-day billing restrictions for crisis intervention mental health and social detoxification services. New daily limits and facility-only requirements are established for multiple codes.
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.
Connecticut Medicaid has implemented new billing procedures for Children's Mental Health Urgent Crisis Centers serving children 18 and younger, effective October 1, 2025. The policy establishes specific billing codes (E&M visits, psychiatric evaluations, and crisis intervention) with important restrictions that E&M codes cannot be billed concurrently with psychiatric evaluation codes.
CareSource Georgia Medicaid is adding prior authorization requirements for skin substitutes, outpatient therapy codes, new Q1 2025 codes, and other outpatient services effective July 10, 2025. This affects a wide range of commonly used therapy and treatment codes that will require pre-approval before services can be rendered.
Virginia Medicaid is eliminating coverage for Community Stabilization services (S9482) effective July 1, 2026, and reducing Mobile Crisis Response (H2011) service limits from 8 hours to 4 hours per encounter. Both changes require CMS approval and will be implemented upon federal authorization. Providers must maintain current enrollment in the PRSS provider portal to avoid claim denials.
Nevada Medicaid has corrected payment issues for procedure code H2011 with HT modifier for Advanced Practice Registered Nurses, Nurse Midwives, and Physician's Assistants. Claims from July 1, 2024 forward will be automatically reprocessed at the correct rate, and the 3 dates per 90 days limit has been removed for School Health 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.
Connecticut Medicaid has updated the reimbursement rate for crisis intervention services (H2011) at Children's Mental Health Urgent Crisis Centers, effective October 1, 2025. Claims with higher billed amounts than the new allowed rate will be retroactively adjusted in January 2026.
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.
Nevada Medicaid has implemented new prior authorization requirements for behavioral health codes H0015 and H0035 for specific provider types, and added PA override options for H0001 and H2011 codes when service limitations are exceeded. These changes only affect behavioral health providers linked to substance use treatment groups.
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.
Health Net California requires specific CPT codes, HIPAA modifiers, and Place of Service 15 (Mobile Unit) for behavioral health mobile crisis services to receive in-network reimbursement rates. Claims not using the specified codes and modifiers will apply standard out-of-network benefits and cost sharing.
Emergency dental services are covered for FFS members age 21 and older, limited to emergency dental services, with an annual benefit not to exceed $1,000 per member per contract year (October 1 to September 30), and unused benefits do not carry over. Use of the updated AHCCCS Daily Trip Report is required for NEMT claims, and claims submitted without the Daily Trip Report will be denied. Crisis services for AIHP members are billed to the RBHA for the first 24 hours and to AIHP after that, using hourly code S9484 and per diem code S9485.
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.
Presbyterian's November 2026 Network Connection newsletter is a provider update covering provider education events, a provider satisfaction survey, QuitNow New Mexico and nutrition coaching referral programs, appointment access standards, a reminder to verify provider directory information every 90 days (next deadline stated as Dec. 27), and crisis services documentation and billing guidance including listed codes. It does not describe a new payer policy change with a stated effective date for claims processing.
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