Back to Insights and Updates for ProvidersMay 2023

Reimbursement update for IEP services effective July 1

Harvard Pilgrim Health Care Commercial  |  Tufts Health Direct  |  Tufts Health Plan Commercial  |  Tufts Health Together  |  Tufts Health Unify

Effective for dates of service beginning July 1, 2023, Point32Health will no longer provide reimbursement for claims submitted with the following modifiers related to services provided in conjunction with a student’s individualized education program (IEP):

  • TM: Individualized education program
  • TR: School-based individualized education program services provided outside the public school district responsible for the student

As a reminder, IEP services are covered through the student’s school district or through the state and are considered non-reimbursable by Harvard Pilgrim Health Care and Tufts Health Plan.

We’ve updated the Tufts Health Plan Modifier Payment Policy to reflect this configuration change. We’re currently unable to update the Commercial Harvard Pilgrim CPT Modifiers Payment Policy due to the cybersecurity issue affecting our Harvard Pilgrim systems, but we will publish the updated version as soon as we are able.

Audrey Kleinberg,
Director, Provider Relations & Communications

Annmarie Dadoly,
Senior Manager, Provider Communications

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