CommercialBilling CodesHigh impact
Behavioral Health (BH) Type of Bill (TOB) Scenarios:
Ambetter·GA · Psychiatry·Claims & Billing
Effective date
Aug 7, 2026
We identified it
Aug 26, 2026
Summary
This policy establishes Type of Bill (TOB) coding guidance for behavioral health services across inpatient, residential treatment, and outpatient settings, specifying which TOB codes (11X, 86X, 13X, 76X) should be used with corresponding revenue and procedure codes. Providers must align their behavioral health billing with the appropriate TOB scenarios to ensure claims are processed correctly by Ambetter Health.
Action Required
By August 7, 2026: Billing team must audit and reconfigure all behavioral health claim submission workflows to ensure correct TOB assignment. Specifically: (1) For inpatient acute care BH services, use TOB 11X with revenue codes 1001, 1002, 114, 116, 124, 126, 134, 136, 144, 146; (2) For residential treatment and detox programs, use TOB 86X with the same revenue codes; (3) For hospital-based PHP/IOP programs, use TOB 13X with revenue codes 905, 906, 912, 913, 907 paired with procedure codes H0015, H0035, S9480, or 90834; (4) For CMHC clinic-based PHP/IOP programs, use TOB 76X with revenue codes 905, 906, 912, 913, 907 and the same procedure codes. Update billing system templates, provider encounter forms, and claim validation rules to enforce correct TOB/revenue/procedure code combinations. Train billing staff and providers on proper TOB selection. Claims submitted with incorrect TOB codes may be denied or subject to delay. Verify compliance before the effective date.