Back to Insights and Updates for ProvidersNovember 2023

Point32Health PPACA coverage alignment

Harvard Pilgrim Health Care Commercial

Harvard Pilgrim Health Care and Tufts Health Plan maintain policies to outline coverage and services for preventive care, in accordance with provisions of the Patient Protection and Affordable Care Act (PPACA). Members are entitled to receive full coverage for preventive care services identified on these policies, with no cost-sharing responsibility, when these services are rendered by an in-network provider.

Effective Jan. 1, 2024, we are making some coding/coverage updates to align processes across legacy products. While coverage for Tufts Health Plan will remain as it is today, the following codes will no longer be covered under the PPACA/preventive services benefit for Harvard Pilgrim commercial members:

  • Cervical cancer screening codes 88160, 88161, and 88162
  • Rh blood typing codes 80055 and 80081

For complete information — including billing guidelines, procedure and diagnosis coding information related to preventive services and immunizations, and more — please refer to Harvard Pilgrim’s updated Patient Protection and Affordable Care Act (Federal Health Care Reform) policy, as well as Tufts Health Plan’s Preventive Services Policy.

Audrey Kleinberg,
Director, Provider Relations & Communications

Annmarie Dadoly,
Senior Manager, Provider Communications

Joseph O’Riordan, Susan Panos, Stephen Wong,

Kristin Edmonston,
Production Coordinator

Kristina Cicelova,
Graphic Designer