CPT, HCPCS, and CDT Procedure Code Changes Effective January 1, 2026

REQUIREMENTS: - Immediately (retroactive to January 1, 2026): Billing team must stop using HCPCS codes G0511 and G0512 for community health center behavioral health services. Replace with CPT procedure codes specified in ForwardHealth Online Handbook Collaborative Care Model topic #22557 for Psychiatric Collaborative Care Management services and topic #23217 for behavioral health integration services. - Before submitting any claims for dates of service on or after January 1, 2026: Update billing system and claim submission processes to reflect all 2026 CPT, HCPCS, and CDT code changes across affected service lines (audiology, dental, disposable medical supplies, medicine, radiology, remote physiological monitoring evaluation and management services, and surgery). - Immediately: Verify that all suspended claims with 2026 procedure codes have automatically processed in ForwardHealth system. Review claim status reports to confirm no manual intervention is needed. - Before January 31, 2026: Providers and billing staff must review the ForwardHealth interactive fee schedules on the ForwardHealth Portal to identify which rendering provider types are allowable for new/revised codes and confirm maximum allowable fees in billing system. - Ongoing: Maintain current documentation per Wisconsin Admin. Code § DHS 106.02(9) and be prepared to submit documentation to Wisconsin DHS upon request. Failure to produce documentation may result in claim denials, payment recoupment, intermediate sanctions, or termination from Medicaid program. - For Community Health Centers (CHCs) specifically: Update claim submission workflows to use correct CPT codes from Online Handbook topics #22557 and #23217 for behavioral health services. Ensure staff understand the code transitions to avoid claim rejections.