Effective for dates of service beginning May 1, 2023, Harvard Pilgrim Health Care’s Commercial plans will no longer provide reimbursement for hydration therapy (CPT codes 96360, 96361, J7030, J7040, J7042, J7050, J7060, J7070, J7120, or J7121) when billed without a requisite diagnosis on the claim for members older than 18 years of age.
This update is in alignment with Tufts Health Plan’s existing reimbursement policy, and in accordance with guidance from the Centers for Medicare and Medicaid Services (CMS), which states that hydration therapy and related drugs should only be covered for certain diagnoses.
Harvard Pilgrim’s Commercial Injectable and Implantable Outpatient Drugs Payment Policy and Emergency Care Payment Policy have been updated to reflect this change in reimbursement.
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