Please refer to the chart below for information on new and updated Payment Policies. For details, access the policies listed below by visiting the Payment Policies section of our Point32Health provider website.

Updates to Payment Policies
Payment Policy TitleProducts AffectedEffective DateAdditional information

Unlisted Procedure Codes

 

Harvard Pilgrim Health Care Commercial, Tufts Health Plan Commercial, Tufts Health Direct, Tufts Health Together, Tufts Health RITogether, Tufts Health One Care (HMO D-SNP), Tufts Health Plan Senior Care Options, Tufts Medicare Preferred 1/1/2026Integrated Point32Health Payment Policy replaces the Harvard Pilgrim Health Care Unlisted and Unspecified Procedure Codes Payment Policy and the Tufts Health Plan Unlisted and Not Otherwise Classified (NOC) Codes Payment Policy.
Inpatient Hospital AdmissionsTufts Health Together, Tufts Health One Care, Tufts Health Plan Senior Care Options1/1/2026Updated policy to include information on interim billing for Tufts Health Together, Tufts Health One Care, and Tufts Health Plan Senior Care Options. Refer to this article for more information. 
General Coding and Claims Editing Harvard Pilgrim Health Care Commercial, Tufts Health Plan Commercial, Tufts Health Direct, Tufts Health Together, Tufts Health RITogether, Tufts Health One Care, Tufts Health Plan Senior Care Options, Tufts Medicare Preferred1/1/2026

As a reminder, in alignment with guidance from the Centers for Medicare & Medicaid Services, the reporting of CPT code 85060 (PC/TC 8) by a physician or other qualified health care professional is appropriate only when it is accompanied by place of service (POS) code 21 (inpatient hospital.) 

Point32Health will deny 85060 (PC/TC 8) when billed without POS 21.

Early InterventionTufts Health Together1/1/2026Policy updated to include additional coding information pertaining to early intervention services delivered at an applied behavioral analysis center, which should be billed using T1015-TL (clinic visit/encounter, all-inclusive [per 15 minutes]). See this article for more information.