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 Payment Policy | 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 | 7/1/2026 | Policy updated for enhanced clarity on billing guidance. In cases when a provider can administer and interpret standardized tests that can be used in both psychological and neuropsychological evaluations, please choose only the code that represents the predominant service being provided. The psychological test evaluation codes (CPT codes 96130-96131) and neuropsychological test evaluation services (CPT codes 96132-96133) should not be billed together in the same episode of care. See this article for more information. |
| Obstetrics/Gynecology | Tufts Health RITogether | 7/1/2026 | Policy updated to allow submission of the following HCPCS codes for doula services for Tufts Health RITogether:
Providers should bill using these codes with the appropriate modifiers (FP, TH, XU) to differentiate between prenatal, postnatal, and attendance at delivery, rather than billing only S9445 with these modifiers.
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| Dermatology | 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 | 7/1/2026 | Minor administrative updates for accuracy and clarity Updated billing guidelines for additional clarity on reporting procedures performed multiple times during the same session. |
| Early Intervention | 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 | 7/1/2026 | Minor administrative updates for accuracy and clarity
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| Emergency Department 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 | 7/1/2026 | Minor administrative updates for accuracy and clarity |
| Telehealth/Telemedicine | 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 | 7/1/2026
| Minor administrative updates for accuracy and clarity |
| Nutritional Counseling | 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 | 7/1/2026
| Minor administrative updates for accuracy and clarity |