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Ambetter Drug Testing and Treatment Procedural Code and Reimbursement Updates

Date: 07/16/26

Effective October 1, 2026, Superior HealthPlan, Ambetter from Superior HealthPlan and Ambetter Health Solutions (ICHRA) provides this reimbursement update for the Texas Health Insurance Marketplace (HIM) and Individual Coverage Health Reimbursement Arrangement (ICHRA) health insurance and HMO plans that the companies provide in Texas.

Unbundling of MH/SUD Testing and Treatment Codes:

Claims will be denied effective 10/01/2026 if:

  • Billed with codes 80305, 80306, 80307, G0480, or G0481 and another claim is already submitted/paid billing G2067, G2068, G2069 (G2069 requires prior authorization), G2073, G2074, G2075, within 7 calendar days for the same member and the same provider; OR
  • Billed with codes G2067, G2068, G2069 (G2069 requires prior authorization), G2073, G2074, G2075, if another claim is already submitted/paid billing codes 80305, 80306, 80307, G0480, or G0481, within 7 calendar days for the same member and the same provider.

Definitive Drug Testing CPT codes 80320-80377 will no longer be reimbursable effective October 1, 2026.

Providers should bill the appropriate G-series bundled laboratory codes* (G0480, G0481) for Definitive Drug Testing.

*Please Note: Ambetter is implementing a clinical payment policy, TX.CP.MP.50-A - Definitive Testing for more than 14 Drugs/Drug Classes effective September 1, 2026. This policy confirms that outpatient confirmatory/definitive (quantitative) drug testing of more than 14 drugs/drug classes is not medically necessary.

If you have questions about this bulletin or other provider resources, please contact your Provider Relations Representative.