As part of our integration work as a combined company, Point32Health has been continuously assessing Payment Policies for our legacy organizations (Harvard Pilgrim Health Care and Tufts Health Plan), with the intent to align them for greater efficiency.
In connection with this work, we’ve created an integrated Point32Health Payment Policy for Acupuncture, replacing the previous Harvard Pilgrim Acupuncture Payment Policy and Tufts Health Plan Payment Policies. As the integrated policy outlines, Point32Health reimburses for a maximum of three acupuncture service codes or a total of three units in any combination per visit.
For Senior products, the following also applies:
- Point32Health limits any combination of 20560-20561 (Needle insertion) or 97810-97814 (Acupuncture) when billed more than 20 times within a 12-month period by any provider.
- Providers should submit modifier KX to indicate medical necessity for all visits beyond the initial 12 visits.
For complete information, please refer to the new Acupuncture Payment Policy.