Marketplace 86X Provider Manual Update and Behavioral Health TOB Billing Guidance

Date: 09/30/26

Ambetter from Louisiana Healthcare Connections would like to inform Behavioral Health providers of an important update regarding Type of Bill (TOB) billing requirements for Marketplace products.

Effective July 29, 2026, billing expectations for 86X Residential Treatment Center (RTC) claims were incorporated into the 2026 Ambetter Provider Manual. Providers should review the updated manual to ensure compliance with current billing requirements.

To provide additional clarification, we are sharing the following Behavioral Health TOB billing scenarios as a supplement to the provider manual update.

Behavioral Health TOB Scenarios

Residential Treatment Center (RTC) Services

• TOB: 86X
• Place of Service/Location: 56
• Description: Used for mental health residential treatment and substance use treatment and detoxification services.
• Examples of Appropriate Inpatient Revenue Codes: 1001, 1002, 0114, 0116, 0124, 0126, 0134, 0136, 0144, 0146.
  
  

Inpatient Hospital Services

• TOB: 11X
• Place of Service/Location: 21
• Description: Used for acute care hospital inpatient admissions.
• Examples of Appropriate Inpatient Revenue Codes: 1001, 1002, 0114, 0116, 0124, 0126, 0134, 0136, 0144, 0146.
   

Outpatient Hospital Services

• TOB: 13X
• Place of Service/Location: 22
• Description: Used for hospital-based outpatient clinics, including hospital-based Partial Hospitalization Programs (PHP) and Intensive Outpatient Programs (IOP).
• Examples of Appropriate Outpatient Revenue Codes: 0905, 0906, 0912, 0913, 0907
• Examples of Corresponding HCPCS/CPT Codes: H0015, H0035, S9480, 90834.
   

Community Mental Health Center (CMHC) Services

• TOB: 76X
• Place of Service/Location: 53
• Description: Used for specialized clinics, including clinic-based PHP and IOP programs.
• Examples of Appropriate Outpatient Revenue Codes: 0905, 0906, 0912, 0913, 0907
• Examples of Corresponding HCPCS/CPT Codes: H0015, H0035, S9480, 90834.
   

The revenue codes and procedure codes listed above are examples only and are not intended to be an all-inclusive listing. Providers should continue to reference applicable billing guidance, contractual requirements, and payer-specific policies to determine appropriate revenue code and procedure code usage.

Behavioral Health providers should review internal billing processes and ensure that claims are submitted using the appropriate TOB, Place of Service, revenue codes, and procedure codes based on the level of care being provided. Failure to bill according to applicable guidelines may result in claim denials or processing delays.

For additional information, please refer to the 2026 Ambetter Provider Manual or contact your Provider Relations representative.