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 |
| Maximum Units | 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 (SCO), Tufts Medicare Preferred | 9/1/2025 | Integrated Point32Health Maximum Units Payment Policy replaces the Harvard Pilgrim Health Care Maximum Units Per Day Payment Policy and the Tufts Health Plan Maximum Units Payment Policy.
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| Outpatient Facility | 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 (SCO), Tufts Medicare Preferred | 9/1/2025 | Integrated Point32Health Outpatient Facility Payment Policy replaces Harvard Pilgrim Health Care’s Outpatient Surgery Payment Policy; Outpatient Facility Fee Schedule Payment Policy; Billing Requirements for Outpatient Revenue Codes Payment Policy; Treatment Room Payment Policy, and the Tufts Health Plan Outpatient Facility Payment Policy and Ambulatory Surgical Center Payment Policy. Integrated policy includes addition of revenue code grid and clarification on use of SG modifier. |
| Surgery | 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 (SCO), Tufts Medicare Preferred | 9/1/2025 | Integrated Point32Health Surgery Payment Policy replaces the Harvard Pilgrim Health Care Surgery Payment Policy and the Tufts Health Plan Surgery Payment Policy. |
| Laboratory and Pathology | 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 (SCO), Tufts Medicare Preferred | 9/1/2025 | Integrated Point32Health Laboratory and Pathology Payment Policy replaces the Harvard Pilgrim Health Care Laboratory and Pathology Payment Policy and the Tufts Health Plan Laboratory and Pathology Payment Policy. |
| Dialysis | 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 (SCO), Tufts Medicare Preferred | 9/1/2025 | Integrated Point32Health Dialysis Payment Policy replaces the Harvard Pilgrim Health Care Dialysis Payment Policy and the Tufts Health Plan Dialysis Payment Policy. |
| Outpatient Behavioral Health & Substance Use Disorder | Tufts Health Together, Tufts Health One Care
| 9/1/2025 | Refer to the Billing updates for mental health centers article in this issue for details on changes in billing instructions for behavioral health urgent care providers. |
| Outpatient Behavioral Health & Substance Use Disorder | Tufts Health Plan Senior Care Options (SCO) | 9/1/2025 | Refer to the Billing updates for mental health centers article in this issue for details on changes in billing instructions for behavioral health urgent care providers. |
| Limited 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 (SCO), Tufts Medicare Preferred | 9/1/2025 | Minor updates to the Related Policies and Resources section. |
| Chiropractic | 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 (SCO), Tufts Medicare Preferred | 9/1/2025 | Minor updates to the Related Policies and Resources section. |