Provider Alert: Unbundled Treatment Codes

Date: 04/01/26

Ambetter Health is committed to continuously evaluating and improving overall payment integrity solutions as required by state and federal governing entities.

Effective April 1, 2026, changes to existing review criteria will go into place.

Unbundled Treatment Codes – Mental Health/Substance Use Disorder Providers: The correct coding edit’s goal is to look for incorrect coding based on the following scenarios:

Scenario 1: Deny claim billed with codes 80305, 80306, 80307, G0480, G0481, G0482, G0483 if another claim is already submitted/paid billing G2067, G2068, G2069, G2073, G2074, G2075, within 7 calendar days for the same member and the same provider.

Scenario 2: Deny claim billed with codes G2067, G2068, G2069, G2073, G2074, G2075, if another claim is already submitted/paid billing codes 80305, 80306, 80307, G0480, G0481, G0482, G0483 within 7 calendar days for the same member and the same provider.

For additional information, please visit Ambetter Health’s Clinical and Payment Policies webpage.

Thank you for your continued partnership with Ambetter Health and serving our members.

For questions or concerns, contact your provider engagement account manager in your area or call Provider Services at 1-833-919-3213, Monday – Friday 7 a.m. to 7 p.m. CT.