What insurance policy changes affect HCPCS H2021?

There are 25 tracked policy changes affecting HCPCS H2021, including updates from Ambetter. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for HCPCS H2021?

Payers that have issued tracked updates for HCPCS H2021 include: Ambetter.

How do I get notified when HCPCS H2021 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to HCPCS H2021. You will receive a daily digest email whenever a new policy change references this code.

Why do payers change policies for HCPCS H2021?

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.

H2021 Insurance Policy Changes

HCPCS H2021 is officially defined as "Community-based wrap-around services, per 15 minutes." HCPCS H2021 is referenced in 25 tracked payer policy changes from Ambetter. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS H2021 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

High impact
Ambetter from Coordinated Care Corporation Billing Code Update for various HCPC H Codes: Effective 01/01/2027
Ambetter·Effective Jan 1, 2027
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.
High impact
Ambetter of Illinois Billing Code Update for various HCPC H Codes: Effective 01/01/2027
Ambetter·Effective Jan 1, 2027
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.
High impact
Ambetter Health Billing Code Update for various HCPC H Codes: Effective 01/01/2027
Ambetter·Effective Jan 1, 2027
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.
High impact
Ambetter from Buckeye Health Plan Billing Code Update for various HCPC H Codes: Effective 01/01/2027
Ambetter·Effective Jan 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.
High impact
Ambetter of Tennessee Billing Code Update for various HCPC H Codes: Effective 01/01/2027
Ambetter·Effective Jan 1, 2027
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.
High impact
Ambetter from Absolute Total Care Billing Code Update for various HCPC H Codes: Effective 01/01/2027
Ambetter·Effective Jan 1, 2027
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.
High impact
Ambetter Health Billing Code Update for various HCPC H Codes: Effective 01/01/2027
Ambetter·Effective Jan 1, 2027
Ambetter Health is discontinuing coverage for 45 HCPCS H codes effective January 1, 2027, while simultaneously adding coverage for H0006. Billing teams must identify all claims using the discontinued codes and establish alternative billing procedures or obtain clarification on replacement codes before the effective date.
High impact
Ambetter of Oklahoma Billing Code Update for various HCPC H Codes: Effective 01/01/2027
Ambetter·Effective Jan 1, 2027
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.
High impact
Ambetter from SilverSummit Healthplan Billing Code Update for various HCPC H Codes: Effective 01/01/2027
Ambetter·Effective Jan 1, 2027
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.
High impact
Ambetter from WellCare of New Jersey Billing Code Update for various HCPC H Codes: Effective 01/01/2027
Ambetter·Effective Jan 1, 2027
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.
High impact
Ambetter of North Carolina Inc. Billing Code Update for various HCPC H Codes: Effective 01/01/2027
Ambetter·Effective Jan 1, 2027
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.
High impact
Ambetter from Magnolia Health Billing Code Update for various HCPC H Codes: Effective 01/01/2027
Ambetter·Effective Jan 1, 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.
High impact
Ambetter from Home State Health Billing Code Update for various HCPC H Codes: Effective 01/01/2027
Ambetter·Effective Jan 1, 2027
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.
High impact
Ambetter from Meridian Billing Code Update for various HCPC H Codes: Effective 01/01/2027
Ambetter·Effective Jan 1, 2027
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.
High impact
Ambetter from Louisiana Healthcare Connections Billing Code Update for various HCPC H Codes: Effective 01/01/2027
Ambetter·Effective Jan 1, 2027
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.
High impact
Ambetter from WellCare of Kentucky Billing Code Update for various HCPC H Codes: Effective 01/01/2027
Ambetter·Effective Jan 1, 2027
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.
High impact
Ambetter Health Billing Code Update for various HCPC H Codes: Effective 01/01/2027
Ambetter·Effective Jan 1, 2027
Effective January 1, 2027, Ambetter Health 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 transition to alternative codes or obtain clarification on approved alternatives to prevent claim denials.
High impact
Ambetter from Peach State Health Plan Billing Code Update for various HCPC H Codes: Effective 01/01/2027
Ambetter·Effective Jan 1, 2027
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.
High impact
Ambetter Health Billing Code Update for various HCPC H Codes: Effective 01/01/2027
Ambetter·Effective Jan 1, 2027
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.
High impact
Ambetter from Arizona Complete Health Billing Code Update for various HCPC H Codes: Effective 01/01/2027
Ambetter·Effective Jan 1, 2027
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.
High impact
Ambetter from Arkansas Health & Wellness Billing Code Update for various HCPC H Codes: Effective 01/01/2027
Ambetter·Effective Jan 1, 2027
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.
High impact
Ambetter of Alabama Billing Code Update for various HCPC H Codes: Effective 01/01/2027
Ambetter·Effective Jan 1, 2027
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.
High impact
Ambetter Health Billing Code Update for various HCPC H Codes Effective 01/01/2027
Ambetter·Effective Jan 1, 2027
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.
High impact
Ambetter from Superior HealthPlan Billing Code Update for various HCPC H Codes Effective 01/01/2027
Ambetter·Effective Jan 1, 2027
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.
High impact
Ambetter from Sunflower Health Plan Billing Code Update for various HCPC H Codes Effective 01/01/2027
Ambetter·Effective Jan 1, 2027
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.

All billing codes J3590 99213 99214 99212 99202 99203

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Ambetter from Coordinated Care Corporation Billing Code Update for various HCPC H Codes: Effective 01/01/2027

Ambetter of Illinois Billing Code Update for various HCPC H Codes: Effective 01/01/2027

Ambetter Health Billing Code Update for various HCPC H Codes: Effective 01/01/2027

Ambetter from Buckeye Health Plan Billing Code Update for various HCPC H Codes: Effective 01/01/2027

Ambetter of Tennessee Billing Code Update for various HCPC H Codes: Effective 01/01/2027

Ambetter from Absolute Total Care Billing Code Update for various HCPC H Codes: Effective 01/01/2027

Ambetter Health Billing Code Update for various HCPC H Codes: Effective 01/01/2027

Ambetter of Oklahoma Billing Code Update for various HCPC H Codes: Effective 01/01/2027

Ambetter from SilverSummit Healthplan Billing Code Update for various HCPC H Codes: Effective 01/01/2027

Ambetter from WellCare of New Jersey Billing Code Update for various HCPC H Codes: Effective 01/01/2027

Ambetter of North Carolina Inc. Billing Code Update for various HCPC H Codes: Effective 01/01/2027

Ambetter from Magnolia Health Billing Code Update for various HCPC H Codes: Effective 01/01/2027

Ambetter from Home State Health Billing Code Update for various HCPC H Codes: Effective 01/01/2027

Ambetter from Meridian Billing Code Update for various HCPC H Codes: Effective 01/01/2027

Ambetter from Louisiana Healthcare Connections Billing Code Update for various HCPC H Codes: Effective 01/01/2027

Ambetter from WellCare of Kentucky Billing Code Update for various HCPC H Codes: Effective 01/01/2027

Ambetter Health Billing Code Update for various HCPC H Codes: Effective 01/01/2027

Ambetter from Peach State Health Plan Billing Code Update for various HCPC H Codes: Effective 01/01/2027

Ambetter Health Billing Code Update for various HCPC H Codes: Effective 01/01/2027

Ambetter from Arizona Complete Health Billing Code Update for various HCPC H Codes: Effective 01/01/2027

Ambetter from Arkansas Health & Wellness Billing Code Update for various HCPC H Codes: Effective 01/01/2027

Ambetter of Alabama Billing Code Update for various HCPC H Codes: Effective 01/01/2027

Ambetter Health Billing Code Update for various HCPC H Codes Effective 01/01/2027

Ambetter from Superior HealthPlan Billing Code Update for various HCPC H Codes Effective 01/01/2027

Ambetter from Sunflower Health Plan Billing Code Update for various HCPC H Codes Effective 01/01/2027