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 Sept. 1, 2026, in addition to certain updates to coverage criteria, we’re implementing the following coding changes to the existing policies outlined below:

Policy

9/1/2026 coding change

Laboratory: Biomarker Testing for Autoimmune Rheumatic Disease

 

Adding CPT code 0522U.

Laboratory: Cardiovascular Disease Risk Assessment

 

Adding CPT code 83876; removing CPT codes 0052U, 0308U, 0309U, 0415U, 0541U.

Laboratory: Colorectal Cancer Screening

 

Adding CPT code 0522U.

Laboratory: Diagnostic Testing of Common Sexually Transmitted InfectionsRemoving CPT codes 86704, 86706, 87340, and G0499 from this policy, which can be found on the Laboratory: Hepatitis Testing policy. Removing CPT codes 0455U, 0463U from the policy. Adding CPT codes 87140, 87270, 87285, 87320, 87494, 87660, and 87810.
Laboratory: Pancreatic Enzyme Testing for Acute PancreatitisAdding CPT code 86141.

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.