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 June 1, 2026, we’re introducing a new related Payment Policy titled Laboratory: Prenatal Testing for Fetal Aneuploidy, as well as implementing the following coding changes to the existing policies outlined below: 

Policy

6/1/2026 coding change

 

Laboratory: β-Hemolytic Streptococcus Testing

 

  • Removing CPT code 87880 from the policy. 
  • Adding CPT code 86581. 

 

 

Laboratory: Biochemical Markers of Alzheimer Disease and Dementia

 

Adding CPT codes 82233, 82234, 83884, 84393, 84394, 0547U, 0548U, 0568U, and 0596U.

 

Laboratory: Cervical Cancer Screening

 

Adding CPT code 87626.

 

Laboratory: Diagnosis of Vaginitis

 

 

  • Removing CPT codes 87661 and 87808.
  • Adding CPT codes 0557U and 0068U. 

 

 

Laboratory: Diagnostic Testing of Common Sexually Transmitted Infections

 

 

  • Removing CPT codes 82565, 82575, 84702, 84703, 86701, 86702, 86703, 86705, 86803, 86804, 87660, 0096U, G0432, G0433, G0435, G0472, G0475, and S3645. 
  • Adding CPT codes 87626 and 87800. 

 

 

Laboratory: Oral Cancer Screening and Testing

 

Adding CPT code 87626. 

 

Laboratory: Pathogen Panel Testing

 

Adding CPT codes 0509U and 0593U. 

 

Laboratory: Serum Testing for Hepatic Fibrosis in the Evaluation and Monitoring of Chronic Liver Disease

 

Removing CPT codes 88341 and 88342.

 

Laboratory: Testing for Diagnosis of Active or Latent Tuberculosis

 

 

  • Removing CPT codes 87149, 87550, 87555, and 87560. 
  • Adding CPT codes 87564 and 0574U.

 

Laboratory: Testing for the Diagnosis of Inflammatory Bowel Disease

 

Adding CPT codes 83630 and 0598U. 

 

Laboratory: Testing for Vector-borne Infections

 

Adding CPT codes 87164 and 87166.

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.