MedicaidBilling CodesMedium impact
Attention Deficit Hyperactivity Disorder (ADHD) Assessment and Treatment
Ambetter·Psychiatry, Pediatrics, Neurology·Provider Bulletin
Effective date
Aug 1, 2026
We identified it
Aug 26, 2026
Summary
Ambetter from Meridian is implementing coding changes effective August 1, 2026 for ADHD assessment and treatment claims. Five CPT codes (84437, 92569, 96116, 96121) will no longer be payable when billed solely with ADHD diagnoses (F90.0-F90.9), and four additional codes (92066, 92545, 92546, 92548, 96369) are being added to the non-payable list under the same conditions. Billing teams must update system edits to deny these codes when paired exclusively with ADHD ICD-10 codes.
Action Required
By July 15, 2026: Billing team must update billing system edits and claim adjudication rules to flag and deny CPT codes 84437, 92569, 96116, 96121, 92066, 92545, 92546, 92548, and 96369 when billed with ONLY ICD-10 diagnosis codes F90.0 through F90.9 (ADHD diagnoses). Specifically: (1) Modify system logic to identify claims with these CPT codes paired exclusively with F90.0-F90.9 diagnoses; (2) Configure automated denial with clear reason code referencing policy CP.BH.124; (3) Alert providers and clinical staff that these codes require additional qualifying diagnoses beyond ADHD to be payable; (4) Update internal billing procedures and training documentation. Note: Claims meeting these criteria will be automatically denied without manual intervention. This applies to Ambetter from Meridian AM Medicaid and AM Marketplace plans only.