What insurance policy changes affect Psychiatry providers?

Psychiatry providers face policy updates from major payers including prior authorization requirements, billing code changes, reimbursement rate adjustments, and coverage criteria revisions. PolicyChanges.app tracks these updates daily across all major insurers.

How often do insurance policies change for Psychiatry?

Insurance payers publish policy changes on rolling schedules: some quarterly, some monthly, and some with immediate effect. Psychiatry practices typically see dozens of relevant changes per year across their contracted payers.

How do I get notified of new Psychiatry policy changes?

Sign up for a free PolicyChanges.app account and create a saved search filtered to Psychiatry. You will get an email when new policy changes match your specialty filter: daily or weekly, your choice, on every plan.

Which payers post the most policy changes affecting Psychiatry?

Based on tracked changes, Psychiatry updates have come from payers including Blue Cross Blue Shield of Nebraska, NY Medicaid, HMSA, Blue Cross and Blue Shield of Minnesota.

PAYER POLICY CHANGES

Psychiatry Insurance Policy Changes

Keeping up with insurance policy changes that affect Psychiatry practices is a full-time job. This page aggregates the latest payer updates (prior authorization rule changes, reimbursement adjustments, billing code additions and removals, and coverage policy revisions) across all major insurers. Changes are identified and summarized daily so Psychiatry providers and their billing teams can act before deadlines pass.

Blue Cross Blue Shield of Nebraska · Effective Nov 15, 2026High impact
Medical Policy Updates Effective 11/15/2026
Blue Cross and Blue Shield of Nebraska (BCBSNE) is implementing two medical policy changes effective 11/15/2026: (1) a new quantity limit policy (I.222) capping physical therapy, occupational therapy, and speech therapy at 25 hours per week per discipline, and (2) a revised autism spectrum disorder policy (I.178) with enhanced documentation, preauthorization, and clinical criteria for ABA services. Both policies require billing and clinical teams to implement new authorization, documentation, and coverage verification workflows.
Blue Cross Blue Shield of Nebraska · Effective Nov 15, 2026High impact
Medical Policy Updates Effective 11/15/2026
Blue Cross Blue Shield of Nebraska implemented two major medical policy updates effective 11/15/2026: (1) New quantity limits capping Physical Therapy, Occupational Therapy, and Speech Therapy at 25 hours per week each, and (2) Revised autism spectrum disorder coverage requiring prior authorization with stricter documentation, assessment, and progress criteria for ABA services. Both policies establish new preauthorization and documentation requirements that will impact claim processing and provider billing workflows.
NY Medicaid · Effective Nov 19, 2026High impact
PADs Requiring PA
Effective November 19, 2026, New York State Medicaid will require prior authorization (PA) for select practitioner-administered drugs (PADs) across five drug classes: botulinum toxin agents (Botox, Dysport, Myobloc, Xeomin, Daxxify), infliximab agents (Remicade and biosimilars), esketamine nasal spray (Spravato), nusinersen (Spinraza), and DMD treatments (Amondys 45, Exondys 51, Viltepso, Vyondys 53). Additional PADs will be added in coming months per NYS Department of Health guidance.
HMSA · Effective Dec 1, 2026High impact
HealthPro News – October 2026
HMSA's October 2026 provider newsletter, issued Oct. 1, 2026, lists several changes with different dates. Effective Jan. 1, 2027, HMSA will no longer cover Transitional Care Management (TCM) codes 99495 and 99496 for commercial and QUEST members, while TCM remains a covered benefit for Medicare members when CMS requirements are met. Effective Dec. 1, 2026, commercial plans will require blood and blood products to be billed with Revenue Code 038X and the applicable HCPCS code, and blood processing and storage services with Revenue Code 039X.
Blue Cross and Blue Shield of Minnesota · Effective Dec 1, 2026High impact
Upcoming Policies effective December 1, 2026
Blue Cross Minnesota is inactivating 12 medical policies effective December 1, 2026, primarily affecting laboratory testing, genetic screening, and diagnostic panels (Barrett's Esophagus surveillance, cardiovascular risk biomarkers, substance use drug testing, cancer genetic panels, vitamin D screening, and others). The billing team must identify all claims currently billed under these policy numbers and determine replacement coverage guidance or discontinue billing for these services.
Sentara Health Plans · Effective Dec 1, 2026High impact
Medical and Clinical Policy Updates - Effective December 1, 2026
Sentara Health Plans has updated 27 medical and surgical policies effective December 1, 2026, including revisions to high-volume procedures like lumbar/cervical fusion, diabetes management, urinary incontinence treatment, and prescription digital therapeutics. Three DME policies (Needless Injections, Mechanical Stretching Devices, Home Traction Devices) have been archived and are no longer covered. Billing teams must review affected policies on the PAL and update prior authorization requirements accordingly.
BCBS Tennessee · Effective Dec 1, 2026High impact
Leuprolide Acetate Depot Suspension [Lupron Depot (1 month) 7.5mg, Lupron Depot (3 month) 22.5mg, Lupron Depot (4-Month) 30 mg, Lupron Depot (6-Month) 45 mg]; Leuprolide acetate depot (3-month 22.5 mg); Lutrate Depot® (3-month 22.5 mg)
BlueCross BlueShield of Tennessee is establishing a new medical policy for Leuprolide Acetate Depot (Lupron Depot and Lutrate Depot) covering four FDA-approved indications: advanced prostate cancer, ovarian cancer (malignant sex cord-stromal tumors), breast cancer (premenopausal with hormone-receptor positive status), and gender dysphoria. All covered uses require prior authorization with specific approval criteria, and the policy includes detailed requirements for gender dysphoria treatment involving age restrictions, provider specialization, and documented informed consent. This policy will supersede any existing guidance effective December 1, 2026.
Ambetter · Effective Dec 20, 2026High impact
New and Updated Clinical Payment Policies: December 20th, 2026 (PDF)
Home State Health Plan implemented seven clinical payment policy changes effective December 20, 2026, affecting behavioral health documentation requirements, burn surgery coverage, fetal surgery criteria, epidural injection frequency limits, therapy services language requirements, genetic testing, and gender-affirming procedures. The most operationally significant change is the Behavioral Health Treatment Documentation Requirements policy (HIM.CP.BH.500/CP.MP.500), which adds nine new documentation elements and modifies existing requirements for mental health claims. Billing teams must immediately review affected policies, update documentation templates and prior authorization workflows, and communicate requirements to providers.
Ambetter · Effective Jan 1, 2027High impact
Ambetter Health of Delaware Billing Code Update for various HCPC H Codes: Effective 01/01/2027
Effective January 1, 2027, Ambetter Health of Delaware will stop covering 45 HCPCS H codes (H0003–H0047, H1011, H2001–H2033) and will begin covering HCPCS code H0006. The practice must stop billing the discontinued codes to Ambetter Delaware members and update charge entry and claim submission processes to reflect coverage changes.
Anthem BCBS · Effective Jan 1, 2027High impact
[Virginia] Payment discontinued for select procedure codes effective
Effective January 1, 2027, HealthKeepers, Inc. (Anthem HealthKeepers Plus Medicaid in Virginia) will discontinue reimbursement for 44 specific procedure codes to align with the Virginia Department of Medical Assistance Services (DMAS) fee schedule. The practice must stop billing these codes for dates of service on or after that date, as claims for discontinued codes will be denied or subject to adjustment and recovery.
Capital Blue Cross · Effective Jan 1, 2027High impact
AB2026-11-003 Pharmacy updates
Capital Blue Cross administrative bulletin 2026-11-003, dated November 1, 2026, updates its Advantage and Value Plus, CHIP, Elite and Exclusive, and Value formularies and pharmacy utilization management programs, with an effective date of January 1, 2027 unless otherwise indicated. The changes include an expanded list of drugs requiring prior authorization, new and modified quantity level limits, new and modified step therapy requirements, and drugs removed from formulary. A footnote states that one change is effective October 1, 2026, and that existing users will have a PA to grandfather them until 10/1.
Molina Healthcare · Effective Jan 1, 2027High impact
10-27-2026 ECM, CICM, Community Supports, CCM, TCS and CHW services for Members transitioning to Medi-Cal Fee-for-Service
Effective January 1, 2027, Medi-Cal managed care plan members with unsatisfactory immigration status will transition to the Medi-Cal Fee-for-Service delivery system. ECM, CICM, Community Supports, CCM and TCS services will no longer be covered for transitioned members in Medi-Cal FFS, while CHW services will continue to remain available after January 1, 2027. Managed care plans must continue authorizing, providing and paying for these services through December 31, 2026.
Humana · Effective Jan 1, 2027High impact
Benzodiazepine Limited Days Supply (New)
Effective January 1, 2027, Humana Illinois Medicaid implements a new pharmacy coverage policy limiting initial benzodiazepine dispensing to a maximum 14-day supply for new users (no benzodiazepine claim in past 60 days), with prior authorization required for initial claims exceeding this limit. Subsequent fills after the initial dispensing follow standard renewal guidelines. This policy applies to 15 benzodiazepine medications across all formulations.
Anthem BCBS · Effective Jan 1, 2027High impact
[Ohio] National accounts: 2027 standard prior authorization requirements
Anthem Blue Cross and Blue Shield is updating prior authorization (PA) requirements for Ohio-based commercial accounts, effective January 1, 2027. The policy establishes comprehensive PA requirements across inpatient admissions, advanced diagnostic testing, DME/prosthetics, transplants, gene therapies, CAR T-cell treatments, mental health services, and numerous surgical procedures. Billing teams must implement these PA requirements in their workflows and systems before the effective date.
Anthem BCBS · Effective Jan 1, 2027High impact
[Virginia] National accounts: 2027 standard prior authorization requirements
Anthem Blue Cross and Blue Shield's October 2026 notice lists the services that will require prior authorization for national accounts commercial members starting January 1, 2027. The list is broad, covering inpatient admissions (including OB stays beyond the federal minimum length of stay), genetic and diagnostic tests, durable medical equipment, transplant and cell and gene therapies, behavioral health programs, cosmetic and reconstructive surgery, and implanted devices, so scheduling and billing need updates before that date.
Ambetter · Effective Jan 1, 2027High impact
Ambetter Health Billing Code Update for various HCPC H Codes: Effective 01/01/2027
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.
MassHealth · Effective Jan 1, 2027High impact
All Provider Bulletin 421: Enrollment Requirement for All Providers on Claims Submitted to MassHealth - Corrected
Effective January 1, 2027, MassHealth will require all ordering, referring, prescribing, attending, supervising, and operating (ORPASO) providers on claims to be enrolled with MassHealth on the date of service (or within 90 days after first date of service for ordered/referred/prescribed services). Claims with unenrolled providers in these roles will be denied. MassHealth is currently sending informational denial messages to prepare providers for this enforcement.
HMSA · Effective Jan 1, 2027High impact
Changes to ASAM 3.5 Residential Treatment Authorizations
Effective January 1, 2027, HMSA will change ASAM 3.5 Residential Treatment authorization procedures for QUEST members aged 21-64. Initial authorizations will be limited to 15 days, with mandatory continued-stay reviews required thereafter based on clinical presentation, treatment progress, discharge barriers, and ASAM criteria.
Anthem BCBS · Effective Jan 1, 2027High impact
[New York] National accounts: 2027 standard prior authorization requirements
Effective January 1, 2027, Anthem is implementing comprehensive prior authorization requirements for National accounts in New York across inpatient admissions, advanced diagnostic testing, specialized DME/prosthetics, transplants, gene therapy, mental health services, and numerous surgical/outpatient procedures. Billing teams must update systems to require pre-certification for these services before claim submission to avoid denials.
Anthem BCBS · Effective Jan 1, 2027High impact
[New York] Billing changes for Adult and Youth Assertive Community Treatment (ACT)
New York Medicaid is replacing six legacy ACT (Assertive Community Treatment) rate and procedure codes (4508, 4509, 4511, 4513, 4514, 4515) with new billing codes and modifiers that distinguish between adult vs. youth programs and capacity slot levels (full, partial, inpatient service). Effective January 1, 2027, ACT providers must stop using old codes and transition to the new billing structure.
Anthem BCBS · Effective Jan 1, 2027High impact
[Ohio] National accounts: 2027 standard prior authorization requirements
Anthem Blue Cross and Blue Shield Ohio is implementing updated prior authorization requirements for national accounts effective January 1, 2027. This comprehensive policy change expands PA requirements across inpatient admissions, advanced diagnostic testing, specialized DME/prosthetics, gene therapies, CAR T-cell treatments, mental health services, and numerous surgical procedures. Billing teams must identify all affected services and update authorization workflows to avoid claim denials.
Anthem BCBS · Effective Jan 1, 2027High impact
[Virginia] National accounts: 2027 standard prior authorization requirements
Anthem Blue Cross and Blue Shield (Virginia) is expanding its prior authorization (PA) requirements effective January 1, 2027, for national accounts. The policy now mandates pre-certification for numerous advanced procedures, diagnostic tests, durable medical equipment, gene therapies, CAR T-cell treatments, transplants, mental health services, and surgical procedures. This represents a comprehensive broadening of PA scope across multiple service categories.
Anthem BCBS · Effective Jan 1, 2027High impact
[Georgia] National accounts: 2027 standard prior authorization requirements
Anthem Blue Cross and Blue Shield is expanding prior authorization (PA) requirements effective January 1, 2027, for Georgia commercial accounts. The policy adds comprehensive PA requirements across multiple service categories including advanced diagnostic testing (genetic testing, liquid biopsy, whole genome sequencing), specialized DME/prosthetics (robotic devices, AAC devices, bone growth stimulation), gene replacement therapies, CAR T-cell immunotherapy treatments, and numerous surgical procedures. Billing teams must update systems to require PA for these newly-covered services to avoid claim denials.
Capital Blue Cross · Effective Jan 1, 2027High impact
AB2026-10-001 Updates and new information
Capital Blue Cross is implementing multiple operational and reimbursement changes effective January 1, 2027, including discontinuation of four behavioral health and surgical supply codes (G0674, G0675, G0678, A4550, A4649), a mandatory transition to ProAuth for all preauthorization requests by December 1, 2026 (phasing out phone/fax), a switch from Equian/Optum to Machinify for itemized bill reviews on December 1, 2026, and a new room and board unbundling policy (FR-02.005) requiring facility providers to bundle certain services into facility fees rather than bill separately.
Blue Cross Blue Shield of Vermont · Effective Jan 1, 2027High impact
Pharmacy Updates
Effective January 1, 2027, this NPF formulary update removes 60+ brand-name drugs from coverage, uptiers 3 medications to require generic alternatives, adds step therapy to Gemtesa, implements quantity limits on diabetic test strips/insulin pumps, and removes Viread from the Health Care Reform List. Billing teams must immediately identify affected patients, update prior authorization workflows, and prepare claims adjustments for the January 1 effective date.
Anthem BCBS · Effective Jan 1, 2027High impact
[California] Review 2027 provider manual updates
Anthem Blue Cross is updating its California Medi-Cal Managed Care provider manual in January 2027 with operational and regulatory changes affecting behavioral health coordination, community supports, payment methods, credentialing standards, and encounter data requirements. Billing teams must review multiple sections including new prior authorization protocols for behavioral health treatments, revised payment method defaults, updated contact procedures, and compliance with new quality measure standards.
Medical Mutual of Ohio · Effective Jan 1, 2027High impact
Mutual News October 2026 Newsletter
Medical Mutual released multiple policy updates effective at staggered dates: new medical policies for debridement and urodynamic testing (effective 2026-12-29), archived the FoundationOne Liquid CDx policy, updated vision therapy to include remote digital software on the investigational/experimental list, removed five VNS CPT/HCPCS codes from behavioral health coverage (codes now align with InterQual database but remain covered for epilepsy), and introduced a new Maternity Care Services Reimbursement Policy (RP-202701) effective 2027-01-01 to replace the current obstetrical policy in response to AMA CPT code revisions.
Nebraska Medicaid · Effective Jan 1, 2027High impact
Coverage for Medically Necessary Institutions for Mental Diseases (IMDs) Stays
Nebraska Medicaid is implementing coverage for medically necessary inpatient and residential stays in Institutions for Mental Diseases (IMDs) for adults with Serious Mental Illness and children with Serious Emotional Disturbance, effective January 1, 2027. Billing teams must use specific HCPCS codes (H0019, H2018, H2020) with per diem rates or tiered inpatient psychiatric rates, submit claims only after stay completion (not monthly), and enforce a 60-day maximum length of stay with an average target of 30 days.
Utah Medicaid · Effective Jan 1, 2027High impact
September 2026 Medicaid Information Bulletin
Utah Medicaid's September 2026 bulletin includes several billing changes that begin January 1, 2027, including telehealth modifiers 93 or 95, service-level reporting for maternity care, per diem billing for residential, partial hospitalization and intensive outpatient behavioral health programs, and single-unit billing for several psychotherapy and evaluation codes. Other items already took effect, including the Spravato observation codes and the home health TE modifier change on July 1, 2026, and the nursing facility ancillary changes, which apply retroactively to services on or after July 1, 2026. Unless otherwise noted in the bulletin, changes take effect on September 1, 2026.
Ambetter · Effective Jan 1, 2027High impact
August Provider Newsletter
Ambetter of North Carolina will stop covering a list of HCPCS H codes starting January 1, 2027, and will cover H0006 from that date. Earlier changes are already effective: CPT 80320-80377 drug testing codes were no longer reimbursable from October 1, 2026, and the prior authorization changes effective October 1, 2026 took effect. The newsletter also covers surrogacy diagnosis codes Z33.3 and Z31.7, behavioral health type of bill guidance, and clinical policy updates effective 11/1/2026.
Ambetter · Effective Jan 1, 2027High impact
Ambetter from Coordinated Care Corporation Billing Code Update for various HCPC H Codes: Effective 01/01/2027
Effective January 1, 2027, Ambetter from Coordinated Care Corporation will discontinue coverage for 42 HCPCS H codes (primarily behavioral health and social services codes) while simultaneously adding coverage for H0006. Billing teams must identify all claims currently using the discontinued codes and transition to alternative coding or request prior authorization to determine covered alternatives.
Ambetter · Effective Jan 1, 2027High impact
Ambetter of Illinois Billing Code Update for various HCPC H Codes: Effective 01/01/2027
Effective January 1, 2027, Ambetter of Illinois will discontinue coverage for 46 HCPCS H codes (behavioral health and social services codes) while adding coverage for H0006. Billing teams must identify all claims currently using the non-covered codes and implement workflow changes to prevent claim denials after the effective date.
Ambetter · Effective Jan 1, 2027High impact
Ambetter Health Billing Code Update for various HCPC H Codes: Effective 01/01/2027
Effective 01/01/2027, Ambetter Health is discontinuing coverage for 52 HCPCS H codes related to alcohol/drug treatment, behavioral health services, and mental health support. Simultaneously, H0006 (Alcohol/drug service, case management) will become newly covered. The billing team must immediately identify affected claims in the system and implement denial protocols for non-covered codes starting January 1, 2027.
Ambetter · Effective Jan 1, 2027High impact
Ambetter from Buckeye Health Plan Billing Code Update for various HCPC H Codes: Effective 01/01/2027
Effective January 1, 2027, Ambetter from Buckeye Health Plan will discontinue coverage for 45 HCPCS H codes commonly used for behavioral health and community support services. Simultaneously, H0006 coverage will begin. The practice must identify all affected claims and implement billing workflow changes to avoid denials.
Ambetter · Effective Jan 1, 2027High impact
Ambetter of Tennessee Billing Code Update for various HCPC H Codes: Effective 01/01/2027
Effective January 1, 2027, Ambetter of Tennessee will discontinue coverage for 46 HCPCS H codes (primarily behavioral health and social services codes) while adding coverage for H0006. The billing team must identify all claims currently using the non-covered codes and transition to alternative billing codes or obtain clarification on approved alternatives before the effective date.
Ambetter · Effective Jan 1, 2027High impact
Ambetter from Absolute Total Care Billing Code Update for various HCPC H Codes: Effective 01/01/2027
Effective January 1, 2027, Ambetter from Absolute Total Care will discontinue coverage for 45 HCPCS H codes (primarily behavioral health and substance abuse treatment services) while adding coverage for H0006. Billing teams must identify all claims using discontinued codes and transition to alternative codes or obtain patient verification of coverage changes.
Ambetter · Effective Jan 1, 2027High impact
Ambetter of Oklahoma Billing Code Update for various HCPC H Codes: Effective 01/01/2027
Effective January 1, 2027, Ambetter of Oklahoma will discontinue coverage for 46 HCPCS H codes commonly used for behavioral health, substance abuse treatment, and related services. Simultaneously, H0006 coverage begins on the same date. The billing team must identify all affected claims and establish processes to deny or redirect these codes for Ambetter Oklahoma members.
Ambetter · Effective Jan 1, 2027High impact
Ambetter from SilverSummit Healthplan Billing Code Update for various HCPC H Codes: Effective 01/01/2027
Effective January 1, 2027, Ambetter from SilverSummit Healthplan will discontinue coverage for 45 HCPCS H codes (primarily behavioral health and support services) while adding coverage for H0006. Billing teams must identify all claims using the discontinued codes and implement alternative billing strategies or obtain patient financial responsibility agreements.
Ambetter · Effective Jan 1, 2027High impact
Ambetter from WellCare of New Jersey Billing Code Update for various HCPC H Codes: Effective 01/01/2027
Effective January 1, 2027, Ambetter from WellCare of New Jersey will discontinue coverage for 45 HCPCS H codes (behavioral health and substance abuse treatment services) while adding coverage for H0006. Billing teams must identify all claims using the discontinued codes and implement alternative billing strategies or prior authorization processes before the effective date.
Ambetter · Effective Jan 1, 2027High impact
Ambetter of North Carolina Inc. Billing Code Update for various HCPC H Codes: Effective 01/01/2027
Effective January 1, 2027, Ambetter of North Carolina Inc. will discontinue coverage for 45 HCPCS H codes (primarily behavioral health and substance abuse treatment services) while adding coverage for H0006. Billing teams must immediately identify affected claims and update billing systems to prevent denials for these services beginning 2027.
Ambetter · Effective Jan 1, 2027High impact
Ambetter from Magnolia Health Billing Code Update for various HCPC H Codes: Effective 01/01/2027
Effective 01/01/2027, Ambetter from Magnolia Health will discontinue coverage for 45 HCPCS H codes (behavioral health and substance abuse treatment services) while adding coverage for H0006. Billing teams must immediately identify affected services, update claim submission logic, and prepare providers for coverage gaps to avoid claim denials.
Ambetter · Effective Jan 1, 2027High impact
Ambetter from Home State Health Billing Code Update for various HCPC H Codes: Effective 01/01/2027
Effective January 1, 2027, Ambetter from Home State Health will discontinue coverage for 45 HCPCS H codes (behavioral health and social services codes) while adding coverage for H0006. Billing teams must identify all claims currently using the non-covered codes and develop transition plans, as continued billing of these codes will result in denials.
Ambetter · Effective Jan 1, 2027High impact
Ambetter from Meridian Billing Code Update for various HCPC H Codes: Effective 01/01/2027
Effective January 1, 2027, Ambetter from Meridian will no longer cover 45 HCPCS H codes (behavioral health and social services codes), while H0006 will begin coverage on that same date. Billing teams must identify all claims using the discontinued codes and implement alternative billing strategies or have claims denied.
Ambetter · Effective Jan 1, 2027High impact
Ambetter from Louisiana Healthcare Connections Billing Code Update for various HCPC H Codes: Effective 01/01/2027
Effective January 1, 2027, Ambetter from Louisiana Healthcare Connections will discontinue coverage for 45 HCPCS H codes (behavioral health and social services) while adding coverage for H0006. Billing teams must identify affected claims, update system edits, and establish alternative coding or prior authorization protocols before the effective date.
Ambetter · Effective Jan 1, 2027High impact
Ambetter from WellCare of Kentucky Billing Code Update for various HCPC H Codes: Effective 01/01/2027
Effective January 1, 2027, Ambetter from WellCare of Kentucky will discontinue coverage for 46 HCPCS H codes (behavioral health and social services codes), while simultaneously activating coverage for H0006. Billing teams must identify all claims currently using the discontinued codes and establish alternative billing strategies or obtain prior authorization requirements before the effective date.
Ambetter · Effective Jan 1, 2027High impact
Ambetter from Peach State Health Plan Billing Code Update for various HCPC H Codes: Effective 01/01/2027
Effective January 1, 2027, Ambetter from Peach State Health Plan will discontinue coverage for 45 HCPC H codes (H0003-H0047, H1011, H2001-H2033) commonly used for behavioral health, substance abuse treatment, and support services. Simultaneously, H0006 coverage will be newly activated. Practices must identify affected claims, update billing systems, and establish alternative coding or coverage verification processes before the effective date.
Ambetter · Effective Jan 1, 2027High impact
Ambetter Health Billing Code Update for various HCPC H Codes: Effective 01/01/2027
Effective January 1, 2027, Ambetter Health will discontinue coverage for 45 HCPCS H codes (primarily behavioral health and substance abuse treatment codes) while simultaneously adding coverage for H0006. Billing teams must immediately identify affected services, audit current patient encounters, and prepare to transition claims to alternative coding or halt billing for these services by the effective date.
Ambetter · Effective Jan 1, 2027High impact
Ambetter from Arizona Complete Health Billing Code Update for various HCPC H Codes: Effective 01/01/2027
Effective January 1, 2027, Ambetter from Arizona Complete Health will discontinue coverage for 45 HCPCS H codes (primarily behavioral health and social services codes) while adding coverage for H0006. Billing teams must identify all claims using the discontinued codes and implement alternative billing strategies to avoid claim denials.
Ambetter · Effective Jan 1, 2027High impact
Ambetter from Arkansas Health & Wellness Billing Code Update for various HCPC H Codes: Effective 01/01/2027
Effective January 1, 2027, Ambetter from Arkansas Health & Wellness will discontinue coverage for 45 HCPCS H codes (primarily behavioral health and substance abuse treatment services) while adding coverage for H0006. Billing teams must identify all claims using the discontinued codes and establish alternative coding or prior authorization strategies to avoid claim denials.
Ambetter · Effective Jan 1, 2027High impact
Ambetter of Alabama Billing Code Update for various HCPC H Codes: Effective 01/01/2027
Effective January 1, 2027, Ambetter of Alabama will discontinue coverage for 45 HCPCS H codes (primarily behavioral health and support services codes) while adding coverage for H0006. Billing teams must immediately identify affected claims and update billing software to prevent denials for non-covered codes after the effective date.

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Medical Policy Updates Effective 11/15/2026

Medical Policy Updates Effective 11/15/2026

PADs Requiring PA

HealthPro News – October 2026

Upcoming Policies effective December 1, 2026

Medical and Clinical Policy Updates - Effective December 1, 2026

Leuprolide Acetate Depot Suspension [Lupron Depot (1 month) 7.5mg, Lupron Depot (3 month) 22.5mg, Lupron Depot (4-Month) 30 mg, Lupron Depot (6-Month) 45 mg]; Leuprolide acetate depot (3-month 22.5 mg); Lutrate Depot® (3-month 22.5 mg)

New and Updated Clinical Payment Policies: December 20th, 2026 (PDF)

Ambetter Health of Delaware Billing Code Update for various HCPC H Codes: Effective 01/01/2027

[Virginia] Payment discontinued for select procedure codes effective

AB2026-11-003 Pharmacy updates

10-27-2026 ECM, CICM, Community Supports, CCM, TCS and CHW services for Members transitioning to Medi-Cal Fee-for-Service

Benzodiazepine Limited Days Supply (New)

[Ohio] National accounts: 2027 standard prior authorization requirements

[Virginia] National accounts: 2027 standard prior authorization requirements

Ambetter Health Billing Code Update for various HCPC H Codes: Effective 01/01/2027

All Provider Bulletin 421: Enrollment Requirement for All Providers on Claims Submitted to MassHealth - Corrected

Changes to ASAM 3.5 Residential Treatment Authorizations

[New York] National accounts: 2027 standard prior authorization requirements

[New York] Billing changes for Adult and Youth Assertive Community Treatment (ACT)

[Ohio] National accounts: 2027 standard prior authorization requirements

[Virginia] National accounts: 2027 standard prior authorization requirements

[Georgia] National accounts: 2027 standard prior authorization requirements

AB2026-10-001 Updates and new information

Pharmacy Updates

[California] Review 2027 provider manual updates

Mutual News October 2026 Newsletter

Coverage for Medically Necessary Institutions for Mental Diseases (IMDs) Stays

September 2026 Medicaid Information Bulletin

August Provider Newsletter

Ambetter from Coordinated Care Corporation Billing Code Update for various HCPC H Codes: Effective 01/01/2027

Ambetter of Illinois Billing Code Update for various HCPC H Codes: Effective 01/01/2027

Ambetter Health Billing Code Update for various HCPC H Codes: Effective 01/01/2027

Ambetter from Buckeye Health Plan Billing Code Update for various HCPC H Codes: Effective 01/01/2027

Ambetter of Tennessee Billing Code Update for various HCPC H Codes: Effective 01/01/2027

Ambetter from Absolute Total Care Billing Code Update for various HCPC H Codes: Effective 01/01/2027

Ambetter of Oklahoma Billing Code Update for various HCPC H Codes: Effective 01/01/2027

Ambetter from SilverSummit Healthplan Billing Code Update for various HCPC H Codes: Effective 01/01/2027

Ambetter from WellCare of New Jersey Billing Code Update for various HCPC H Codes: Effective 01/01/2027

Ambetter of North Carolina Inc. Billing Code Update for various HCPC H Codes: Effective 01/01/2027

Ambetter from Magnolia Health Billing Code Update for various HCPC H Codes: Effective 01/01/2027

Ambetter from Home State Health Billing Code Update for various HCPC H Codes: Effective 01/01/2027

Ambetter from Meridian Billing Code Update for various HCPC H Codes: Effective 01/01/2027

Ambetter from Louisiana Healthcare Connections Billing Code Update for various HCPC H Codes: Effective 01/01/2027

Ambetter from WellCare of Kentucky Billing Code Update for various HCPC H Codes: Effective 01/01/2027

Ambetter from Peach State Health Plan Billing Code Update for various HCPC H Codes: Effective 01/01/2027

Ambetter Health Billing Code Update for various HCPC H Codes: Effective 01/01/2027

Ambetter from Arizona Complete Health Billing Code Update for various HCPC H Codes: Effective 01/01/2027

Ambetter from Arkansas Health & Wellness Billing Code Update for various HCPC H Codes: Effective 01/01/2027

Ambetter of Alabama Billing Code Update for various HCPC H Codes: Effective 01/01/2027