Back to Insights and Updates for ProvidersNovember 2023

Tufts Health Direct outpatient cost sharing updates

Tufts Health Direct

Effective Jan. 1, 2024, the following outpatient cost share updates will apply to Tufts Health Direct members:

  • Outpatient day surgery and medical outpatient visits: In addition to ambulatory surgical locations (place of service [POS] 24), member cost sharing will apply to outpatient surgery at off campus (POS 19) and on campus (POS 22) outpatient hospital locations. Appropriate member cost sharing will also apply to office locations (POS 11) for applicable surgical services.
  • Outpatient tests and diagnostic services: Member cost share will apply to the following:
    • Outpatient tests
    • Non-lab, non-radiology diagnostics
    • Lab and pathology services, including:
      • Gastroenterology services
      • Cardiovascular services
      • Stress tests
      • Select pulmonary services
      • Select hearing services
      • Select speech services

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