Medicare AdvantageCoverageHigh impact
Ambetter Health Billing Code Update for various HCPC H Codes: Effective 01/01/2027
Ambetter·IN · Psychiatry, General Practice·Claims & Billing
Effective date
Jan 1, 2027
We identified it
Oct 10, 2026
Summary
Effective 01/01/2027, Ambetter Health will discontinue coverage for 45 HCPC H codes (primarily behavioral health and community support services) and will begin covering HCPC code H0006. Billing teams must update coding practices and prior authorization workflows to reflect these coverage changes.
Action Required
By 01/01/2027: Billing team must update billing system and claim submission protocols to reflect coverage changes for Ambetter Health members. Specifically: (1) Configure billing software to deny or reject claims for the 45 discontinued H codes (H0003, H0004, H0005, H0007–H0047, H1011, H2001–H2033 except H0006) with appropriate remittance advice; (2) Enable billing system to accept and process claims for H0006, which transitions from non-covered to covered status; (3) Update provider and clinical staff training materials to reflect that these behavioral health and community support services are no longer reimbursable by Ambetter Health effective 01/01/2027; (4) Establish workflow to identify affected Ambetter Health members and communicate alternative coverage options or service modifications. Failure to implement these changes will result in claim denials and revenue loss. Contact your Ambetter Health Provider Relations Representative for clarification on billing alternatives.