HCPCS H2016 is officially defined as "Comprehensive community support services, per diem." HCPCS H2016 is referenced in 37 tracked payer policy changes from Ambetter, Sentara Health Plans, and 5 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS H2016 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.
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.
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 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.
Virginia Medicaid is redesigning behavioral health services, retiring four Community Mental Health Rehabilitative Services (CMHRS) codes (H2012, H2016, H0046, H2017) effective June 30, 2027, and implementing five new behavioral health service codes (CPST-Adult, CPST-Youth Community, CPST-Youth School, CSC, Clubhouse) effective July 1, 2027. All current members receiving the retiring services must transition to alternative behavioral health services by the deadline. The practice must update provider enrollment, verify credentials, and prepare for service authorization transitions over the next 6-12 months.
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.
Effective September 1, 2025, managed care entities must pay behavioral health urgent care providers (BHUCs) one encounter bundle per patient per day instead of each individual service, billed as H2013 with modifier HB for adults or HA for children and adolescents, at no less than the MassHealth fee-for-service minimum rate for the bundle code. The services listed in Table 2 are included in the bundle and must be reported on the claim with a zero charge. The GJ modifier for urgent services is not allowed beginning September 1, 2025.
A 2% across-the-board Health First Colorado provider rate reduction applies to dates of service beginning July 1, 2026, with exemptions for managed care, pharmacy, RHCs, FQHCs, pediatric behavioral therapy, select NICU and neonatal services, select maternity services, and family planning services. Procedure codes 97535 and 97537 are no longer covered as of July 1, 2026, and CPT 77063 became a covered benefit that must be billed on the same claim as CPT 77067. Effective August 1, 2026, PT 25 and PT 16 claims will be denied when billed for certain behavioral health supportive and team-based services in fee-for-service or to the Regional Accountable Entities.
Blue Cross of Idaho updated HCBS300 prior authorization requirements for Medicare Medicaid Coordinated Plan (MMCP) and Blue Cross Idaho Medicaid Plus (BCIMP) members, effective December 2023. The policy clarifies that prior authorization must be obtained from the care coordination team before rendering long-term support services (LTSS) and home and community-based services (HCBS). Services rendered without prior authorization will result in claim denials. The policy also specifies that no prior authorization is required for crisis services, but 24-hour notification to Blue Cross of Idaho is mandatory.
Point32Health updated multiple Medical Necessity Guidelines affecting prior authorization requirements, coverage decisions, and billing procedures. Key changes include expanded peer recovery coach coverage with no prior auth for CPT H2016-HM, new complex care differential rates for personal care assistance using HCPCS T1019 with modifier TG, and exclusion of coverage for Vivally bladder control therapy and Lantrida pancreatic islet therapy.
MassHealth now covers two new specialized services for pregnant and postpartum members with substance use disorders: Peer Recovery Coach Services and Recovery Support Navigator Services. New billing codes H2016-HM-HD and H2015-HF-HD are available with mandatory minimum reimbursement rates.
Health First Colorado across-the-board provider rate increases of 3.0% apply to dates of service beginning July 1, 2023, along with targeted rate rebalances for listed service categories including cardiology, radiology, and primary care and evaluation and management. A directed payment minimum rate fee schedule applies to behavioral health codes H0036, H0037, H2015, H2016, H2021, H2022 and H2033 effective July 1, 2023. Family planning-related services for members in the Emergency Medical Services and Reproductive Health Care Program category have a $0 co-pay effective July 1, 2023, and coverage of laboratory codes 0202U, 0223U, 0224U, 0225U, 0226U, 0240U and 0241U remains after the end of the public health emergency.
Watch H2016
Get one email when a payer policy names H2016, 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 H2016
Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for H2016 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.