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, Tufts Medicare Preferred | 9/1/2026 | Minor administrative updates for accuracy and clarity
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| Interim Billing | Harvard Pilgrim Health Care Commercial | 9/1/2026 | Policy archived. Refer to the Inpatient Hospital Admissions Payment Policy for information on interim billing. |
| 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, Tufts Medicare Preferred | 9/1/2026 | Minor administrative updates for accuracy and clarity
|
| Limited Services Clinics | 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 | 9/1/2026 | Minor administrative updates for accuracy and clarity
|
| 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, Tufts Medicare Preferred | 9/1/2026 | Minor administrative updates for accuracy and clarity |
| 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, Tufts Medicare Preferred | 9/1/2026 | Minor administrative updates for accuracy and clarity, including definition of once-yearly reimbursement as reimbursement every 365 days. |
| Chiropractic 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 | 9/1/2026 | Minor administrative updates for accuracy and clarity |
| 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, Tufts Medicare Preferred | 9/1/2026 | Minor administrative updates for accuracy and clarity |
| Obstetrics/Gynecology | Tufts Health Direct | 11/1/2026 | Policy will be updated to include information on denial of CPT code 99459 when billed for services provided to Tufts Health Direct members. Refer to this article for detailed explanation. |
| Imaging | Tufts Health Direct | 11/1/2026 | Policy will be updated to include information on denial of CPT codes 76376 and 76377 when billed for services provided to Tufts Health Direct members. Refer to this article for detailed explanation. |
| Laboratory: Biomarker Testing for Autoimmune Rheumatic Disease | Harvard Pilgrim Health Care Commercial | 9/1/2026 | Minor administrative updates for accuracy and clarity
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| Laboratory: Cardiovascular Disease Risk Assessment | Harvard Pilgrim Health Care Commercial | 9/1/2026 | Minor administrative updates for accuracy and clarity
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| Laboratory: Colorectal Cancer Screening | Harvard Pilgrim Health Care Commercial | 9/1/2026 | Minor administrative updates for accuracy and clarity
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| Laboratory: Diagnostic Testing of Common Sexually Transmitted Infections | Harvard Pilgrim Health Care Commercial | 9/1/2026 | Minor administrative updates for accuracy and clarity
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| Laboratory: Pancreatic Enzyme Testing for Acute Pancreatitis | Harvard Pilgrim Health Care Commercial | 9/1/2026 | Minor administrative updates for accuracy and clarity
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