Medicare AdvantagePrior AuthHigh impact
Provider Billing Update re: HCPCS H0019 Effective 8/29/2025
Ambetter·AZ · Psychiatry·Prior Authorization
Effective date
Aug 29, 2025
We identified it
Aug 26, 2026
Summary
Effective August 29, 2025, Ambetter from Arizona Complete Health now requires prior authorization for HCPCS code H0019 (behavioral health; long-term residential per diem). Providers billing this code must obtain prior authorization before submitting claims to avoid denials.
Action Required
Effective immediately (8/29/2025): Billing team must update billing software and submission workflows to require prior authorization for HCPCS code H0019 for all Ambetter from Arizona Complete Health claims. Notify all providers and clinical staff that H0019 claims can no longer be submitted without prior auth. Contact Provider Relations Representative if questions arise. Claims submitted without prior authorization will be denied.