Medicare AdvantageCoverageHigh impact
Ambetter Health Billing Code Update for CPT Codes 80320-80377 Effective 10/01/2026
Ambetter·MI·Coding
Effective date
Oct 1, 2026
We identified it
Aug 26, 2026
Summary
Effective October 1, 2026, Ambetter Health will no longer reimburse CPT codes 80320-80377 (Definitive Drug Testing Procedures). Providers must transition to billing G-series bundled laboratory codes instead. This is a coverage elimination requiring immediate billing system updates and provider communication.
Action Required
By October 1, 2026: Billing team must update billing software to block reimbursement for CPT codes 80320-80377 under Ambetter Health plans and redirect to appropriate G-series bundled laboratory codes. Before the effective date, identify all current claims using these codes for Ambetter members and determine corresponding G-series codes to use. Notify all providers who order definitive drug testing that these codes are no longer reimbursable by Ambetter effective 10/01/2026 and provide guidance on G-series code alternatives. Update billing system rules to deny claims with CPT 80320-80377 for Ambetter plans. Failure to transition will result in claim denials and lost revenue.