Vermont Updates Mental Health Parity Rule: New Primary Care Procedure Codes Effective January 1, 2026

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VT| The Vermont Department of Financial Regulation‘s Rule I-2013-01 (Revised) provides guidelines for distinguishing primary from specialty mental health and substance abuse services in health insurance plans to ensure equitable co-pays, mandating that primary services by mental health providers carry no higher co-pay than those by primary care providers, while specialty services align with specialist medical co-pays. It lists specific CPT/HCPCS procedure codes in Appendices A (2013 codes, effective 2013) and B (2024 additions, effective January 1, 2026) for common outpatient services like psychiatric evaluations, psychotherapy sessions, group counseling, and substance abuse treatments. The rule requires biennial or five-year stakeholder reviews for updates, effective for plans issued or renewed on or after January 1, 2026.

Click here to see Revised VT Rule I-2013-01

  • Bulletin
  • Vermont
  • Department of Insurance

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