News
Unbundled Treatment Codes: MH/SUD Providers
Date: 01/12/26
Thank you for your continued partnership with Ambetter Health. As you know, we are committed to continuously evaluating and improving overall Payment Integrity solutions as required by State and Federal governing entities. We are informing you of changes to existing review criteria that will go into place on or after 03/01/2026.
Description of Changes | Lines of Business |
Unbundled Treatment Codes: MH/SUD Providers: This 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 pt 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 pt and the same provider. | Marketplace & Medicare |
Supporting References:
- Medicare Benefit Policy Manual Chapter 17 Opioid Treatment Programs (PDF)
- The bundled payments for Opioid Use Disorder treatment services include medication administration and toxicology testing.
- National Government Services
- HCPCS codes G2067 through G2075 describe the weekly bundled services provided to Medicare beneficiaries and are defined as seven continuous days of services.
- These weekly bundle HCPCS codes include MAT administration and dispensing, patient intake activities, substance use disorder counseling and individual/group therapy, drug testing and/or periodic patient assessments.
- The threshold for billing the codes describing weekly episodes (HCPCS codes G2067-G2075) is the delivery of at least one service in the weekly bundle.
Thank you for your continued participation and cooperation in our ongoing efforts to render quality health care to our members. We look forward to helping you provide the highest quality of care for our members.