Back to Insights and Updates for ProvidersJuly 2024

Reminder: removal of certain prior authorization requirements

Harvard Pilgrim Health Care Commercial  |  Tufts Health One Care  |  Tufts Health Plan Commercial  |  Tufts Health RITogether  |  Tufts Health Together

As a reminder, in connection with Point32Health’s ongoing initiative to support our provider partners in efficiently delivering high-quality care, the following procedures and associated codes no longer require prior authorization for our Harvard Pilgrim Commercial, Tufts Health Plan Commercial, Tufts Health Direct, Tufts Health Together, Tufts Health RITogether, and Tufts Health One Care members:

  • Laparoscopic Cholecystectomy ( CPT 47562, 47563, 47564)
  • Transcervical Radiofrequency Ablation of Uterine Fibroids (CPT 58580)
  • Prostatectomy, Transurethral Resection (TURP) (CPT 52601, 52630, 52648)

Please continue to check future issues of Insights and Updates for Providers for information on subsequent changes intended to further our goal of minimizing your administrative burden while expediting member care.

For guidance on submitting notifications and prior authorization requests, please refer to the Referral, Notification and Authorization Policy in the Harvard Pilgrim Health Care Commercial Provider Manual and the Referrals, Prior Authorizations and Notifications section of the Tufts Health Plan Provider Manual. Additionally, look to Point32Health’s Medical Necessity Guidelines page to review clinical coverage criteria.

Annmarie Dadoly,
Senior Manager, Provider Communications

Joseph O’Riordan, Susan Panos, Ellen Gustavson, Ryan Francis, Stephen Wong,

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