Effective for dates of service on or after Nov. 1, 2026 for Tufts Health Direct members, we’re updating our reimbursement practices for pelvic exams and 3D rendering with interpretation and reporting and will no longer reimburse the CPT codes identified below. 

  • Pelvic exams: Because clinical staff time and supplies associated with a pelvic exam are included in reimbursement for the primary office visit code, CPT code 99459 — an add-on code for pelvic exam practice expenses performed during an evaluation and management (E/M) or preventive visit — will be denied when billed.
  • Imaging procedures: Considered integral to the primary imaging procedure, CPT codes 76376 and 76377 — which include 3D rendering with interpretation and reporting — will be denied when billed, regardless of modifier usage.

These updates align with the current reimbursement practice for Harvard Pilgrim Health Care Commercial members and are reflected in our Obstetrics/Gynecology and Imaging Services Payment Policies. We encourage you to review the updated policies in the Payment Policies section of our provider website.