Start free

PolicyChanges tracks payer policy changes for medical practices and tells you what to do before they take effect.

Create a free accountPolicy Monitoring is free. No card required.
← Back to list
AmbetterExchange · Billing Codes · Medical Policy · TX · Pathology, PsychiatryHigh impact

Ambetter Health Drug Testing and Treatment Procedural Code and Reimbursement Updates

Effective date
Oct 1, 2026
Identified
Aug 26, 2026

Summary

This historical notice, dated 07/17/26, is Ambetter's reimbursement update for the Texas Health Insurance Marketplace and ICHRA health insurance and HMO plans. It states that definitive drug testing CPT codes 80320-80377 will no longer be reimbursable effective October 1, 2026, and that providers should bill G0480 or G0481 for definitive drug testing. It also states that claims will be denied effective 10/01/2026 for specified MH/SUD testing and treatment code pairs billed for the same member and provider within 7 calendar days, and that clinical payment policy TX.CP.MP.50-A, on definitive testing for more than 14 drugs or drug classes, takes effect September 1, 2026.

Get alerts when payers change rules like this one

We check Ambetter and other payers every day and email you when a change matches your specialty and state.

Get Ambetter alertsPolicy Monitoring is free. No card required.

What to do

Action · 4 steps
01Already effective 2026-10-01: Billing team: bill G0480 or G0481 for definitive drug testing, since CPT codes 80320-80377 will no longer be reimbursable.
02Avoid billing any of codes 80305, 80306, 80307, G0480 or G0481 together with any of G2067, G2068, G2069, G2073, G2074 or G2075 for the same member and same provider within 7 calendar days of each other, since the source says those claims will be denied.
03G2069 requires prior authorization, so get it before billing G2069.
04For outpatient confirmatory or quantitative drug testing of more than 14 drugs or drug classes, the source states that testing is not medically necessary, effective September 1, 2026.

Codes mentioned

803058030680307G0480G0481G2067G2068G2069G2073G2074G2075

Original notice

Ambetter Health Drug Testing and Treatment Procedural Code and Reimbursement Updates
ambetterhealth.com · Always check the source before changing claims.
View original ↗

Related changes

See all Ambetter changes →
Update for HCPCS Codes G0482 and G0483MediumNo effective date · Medical PolicyUpdate for HCPCS Codes G0482 and G0483HighNo effective date · Medical PolicyUpdate for HCPCS Codes G0482 and G0483HighNo effective date · Medical PolicyUpdate for HCPCS Codes G0482 and G0483HighEffective Jun 4, 2026 · Medical PolicyBrowse every Ambetter change in the policy list

Related policy hubs

Ambetter policiesTX policy changesPathologyPsychiatryCode 80305Code 80306Code 80307Code G0480Code G0481Code G2067Code G2068Code G2069Code G2073Code G2074Code G2075

Summaries are AI-assisted. Always confirm against the original payer notice.

What is PolicyChanges

One workspace for payer rules, prior auth, coding and compliance

Medical practices use PolicyChanges to catch payer changes before they cause denials. Every change is summarized in plain English, with the codes involved, the date it takes effect and what to do.

Policy MonitoringPayer policy, prior auth and coding changes, filtered to your saved searchesOIG ScreeningStaff and vendors screened every month against OIG LEIE, SAM.gov and state Medicaid listsPrior Auth LookupKnow if a service needs prior authorization before you schedule itCredentialing TrackerLicenses, CAQH, Medicare revalidation and payer enrollments, with reminders before anything lapsesCompliance CenterKeep your HIPAA program documented and ready to show
Start freePolicy Monitoring is free. No card required.
Get alerts for changes like thisPolicy Monitoring is free. No card required.Create a free account