Ambetter H Codes Not Covered January 1, 2027: The 48-Code List
If your practice bills Ambetter for behavioral health, a long list of H codes stops paying on January 1, 2027. Ambetter posted the change state by state in mid-2026 without replacement codes, so the work of remapping services falls to the practice, and the time to do it is before the first denials arrive.
Short answer
Effective January 1, 2027, Ambetter Health will no longer cover 48 HCPCS H codes, including H0004 (behavioral health counseling), H0005 (group SUD counseling), H2011 (crisis intervention), H2015 (comprehensive community support), and the assertive community treatment codes H0039 and H0040. It will begin covering H0006, alcohol and/or drug case management. The change is Ambetter's Marketplace policy, not a national code deletion or a Medicaid change.
What changes on January 1, 2027
Ambetter's notices list 48 H codes that will no longer be covered and one code, H0006, that will be covered for the first time. The notices do not name replacement codes; they direct providers to their Provider Relations representative.
| Range | Codes no longer covered from January 1, 2027 | Count |
|---|---|---|
| H0003 to H0047 | H0003, H0004, H0005, H0007, H0008, H0009, H0010, H0011, H0012, H0013, H0014, H0016, H0019, H0021, H0024, H0026, H0027, H0028, H0029, H0030, H0034, H0037, H0039, H0040, H0041, H0042, H0043, H0044, H0045, H0046, H0047 | 31 |
| H1011 | H1011 | 1 |
| H2001 to H2033 | H2001, H2010, H2011, H2012, H2013, H2015, H2016, H2018, H2021, H2022, H2028, H2029, H2030, H2031, H2032, H2033 | 16 |
The same 48 codes appear in the Indiana, Iowa, Georgia, and Kansas notices.
Where Ambetter posted it
| State | Plan | Posted | Notice |
|---|---|---|---|
| Indiana | Ambetter Health (MHS Indiana) | June 22, 2026 | Read the notice |
| Iowa | Ambetter Health of Iowa (Iowa Total Care) | June 17, 2026 | Read the notice |
| Georgia | Ambetter from Peach State Health Plan | June 22, 2026 | Read the notice |
| Kansas | Ambetter from Sunflower Health Plan | August 3, 2026 | Read the notice |
Ambetter operates in other states too. Check your state plan's provider news for its version.
Commonly billed codes that are not on the list
Several codes behavioral health practices bill often do not appear on the list: H0001, H0002, H0015, H0031, H0032, H0036, H0038, H2014, H2017, H2019, H2020. Not being on the list does not guarantee coverage for every service or plan, so confirm against your contract.
What this is, and is not
- It is a payer policy. Ambetter is a Marketplace product. The codes remain valid HCPCS codes.
- It is not a Medicaid change. State Medicaid programs and their managed care plans set their own H code coverage.
- It is not a CMS deletion. Other commercial plans and Medicaid can still pay these codes where their policies allow.
What to do before January 1
- Find your exposure. Pull the last 12 months of Ambetter claims and count those using any of the 48 codes.
- Ask how to bill the service instead. The notices give no replacements, so ask Provider Relations, in writing, how each affected service should be billed from January 1.
- Check authorizations that cross the date. Services authorized under a listed code for dates in 2027 need a decision before the date.
- Tell affected patients. Members whose care depends on a listed code may face changes or out-of-pocket costs.
- Watch the first remittances. Track January 2027 Ambetter denials by code so any service that slipped through is caught in days, not months.
For each code's descriptor and billing rules, see H codes in behavioral health and behavioral health modifiers.
Sources: Ambetter provider notices linked above, read October 16, 2026. Payers revise notices; confirm with your plan before changing billing.
Frequently asked questions
Which H codes will Ambetter stop covering in 2027?
Forty-eight: H0003 to H0005, H0007 to H0014, H0016, H0019, H0021, H0024, H0026 to H0030, H0034, H0037, H0039 to H0047, H1011, H2001, H2010 to H2013, H2015, H2016, H2018, H2021, H2022, and H2028 to H2033, effective January 1, 2027.
Is H0004 covered by Ambetter in 2027?
No. H0004, behavioral health counseling and therapy per 15 minutes, is on the list of codes Ambetter stops covering on January 1, 2027.
What H code does Ambetter start covering in 2027?
H0006, alcohol and/or drug services, case management, effective January 1, 2027.
Does the Ambetter H code change affect Medicaid?
No. Ambetter is a Marketplace product. State Medicaid programs and their managed care plans set their own coverage.
What should practices bill instead?
The notices do not name replacement codes. Ask your Ambetter Provider Relations representative in writing how each affected service should be billed from January 1, 2027.
Payer changes caught before they deny.
See Stable flag claims that use codes a payer is dropping and route them for review before submission.
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