Laboratory Payment Policies: Dec. 1, 2026 updates
October 2026| Harvard Pilgrim Health Care Commercial
As we’ve announced in previous issues of Insights and Updates for Providers, Point32Health operates a laboratory benefit management program for Harvard Pilgrim Health Care Commercial members. We utilize automated claims edits (post-service, pre-payment) to ensure consistency with the guidelines for laboratory services, tests, and procedures performed in office, hospital outpatient, and independent laboratory locations.
As part of this program, we maintain a number of evidence-based Payment Policies which are aligned with the latest scientific research to determine the appropriateness of lab testing.
Effective for dates of service beginning Dec. 1, 2026, in addition to certain updates to coverage criteria, we’re implementing the following coding changes to the existing policies outlined below:
Policy | 12/1/2026 coding change |
| Laboratory: Colorectal Cancer Screening |
Adding CPT code 0421U. |
| Laboratory: Diabetes Mellitus Testing |
Adding CPT code 82950. |
| Laboratory: Identification of Microorganisms using Nucleic Acid Probes |
Adding CPT code 87638. |
| Laboratory: Pathogen Panel Testing | Adding CPT codes 87627, 0600U, 0601U, and 0610U. |
To review these updated policies (and any others) in further detail, refer to the Payment Policies section of our provider website.
In addition, consistent with Maine regulations, redlined versions of the above-referenced policies are posted temporarily.