The work of streamlining policies and processes across our Harvard Pilgrim Health Care and Tufts Health Plan lines of business remains an important priority for Point32Health, as we strive to deliver a seamless provider experience. As part of that effort, we are introducing a new integrated Point32Health Site of Service Payment Policy. This merged policy will replace the previous Harvard Pilgrim Site of Service Payment Policy — and now apply to all products. For more information, check out our full list of Payment Policies.
Changes to site of service differential logic
Consistent with the Centers for Medicare and Medicaid Services (CMS), reimbursement for services performed in a non-facility setting may be higher and reimbursement for services performed in a facility may be lower due to the site of service differential rate.
Effective for dates of service beginning Sept. 1, 2025, the site of service differential will be consistently applied to all Point32Health products. We are updating our site of service logic to reflect the same list of place of service (POS) codes established by CMS in the Medicare Claims Processing Manual’s Publication 100-04, CH 26, sect 10.5 – Place of Service Codes (POS) and Definitions.
Telehealth reimbursement update
In addition to the change in site of service logic, Point32Health will also update our methodology for the reimbursement of services rendered via telehealth/telemedicine.
Currently, a 20 percent decrement is applied to claims for medical services billed with POS 02 (telehealth provided other than in patient’s home) and POS 10 (telehealth provided in patient’s home) for Commercial products and Tufts Health Direct. For dates of service beginning Sept. 1, 2025, we will no longer apply this 20 percent decrement; telehealth and telemedicine services will instead be reimbursed in accordance with the site of service differential logic dependent upon the place of service billed.
For complete information, please refer to the Telehealth/Telemedicine Payment Policy. (Consistent with Maine regulations, a redlined version of this policy is also posted temporarily.)