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 Title | Products Affected | Effective Date | Additional information |
| Behavioral Health and Substance Use Disorder | Harvard Pilgrim Health Care Commercial, Tufts Health Plan Commercial | 6/1/2026 | Minor administrative updates for accuracy and clarity |
| Inpatient and Intermediate Behavioral Health/Substance Use Disorder Facility | Tufts Health Plan Senior Care Options, Tufts Medicare Preferred | 6/1/2026 | Minor administrative updates, including addition of further revenue codes for intermediate services
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| Inpatient and Intermediate/Diversionary Behavioral Health/Substance Use Disorder (BH/SUD) Facility | Tufts Health Direct, Tufts Health Together, Tufts Health RITogether, Tufts Health One Care | 6/1/2026 | Minor administrative updates, including addition of coding for Individualized Treatment and Stabilization services |
| Outpatient Behavioral Health & Substance Use Disorder | Tufts Health Plan Senior Care Options, Tufts Medicare Preferred | 6/1/2026 | Minor administrative updates for accuracy and clarity |
| Outpatient Behavioral Health & Substance Use Disorder | Tufts Health Direct, Tufts Health Together, Tufts Health RITogether, Tufts Health One Care | 6/1/2026 | Minor administrative updates, including removal of PA language for PASS services for RITogether members and addition of intern-level modifiers and MHPRR modifier requirement |
| Opioid Use Disorder (OUD) Services and Medication Assisted Treatment (MAT) | Tufts Health Direct, Tufts Health Together, Tufts Health RITogether, Tufts Health One Care | 6/1/2026 | Minor administrative updates for accuracy and clarity |
| Individual Consideration Services | Tufts Health Direct, Tufts Health Together | 6/1/2026 | Minor administrative updates for accuracy and clarity |
| Allergy Testing and Treatment | 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 Preferred | 6/1/2026 | Minor administrative updates for accuracy and clarity |
| Cardiac Services | 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 Preferred | 6/1/2026 | Minor administrative updates for accuracy and clarity |
| Ambulance and Transportation Services | 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 Preferred | 6/1/2026 | Minor administrative updates for accuracy and clarity |
| Serious Reportable Events and Provider Preventable Conditions | 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 Preferred | 6/1/2026 | Policy updated for enhanced clarity and to provide additional state and federal resources for reference. See this article for more information. |