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 |
Oral 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 | 12/1/2025 | Integrated Point32Health Payment Policy replaces the Harvard Pilgrim Health Care Oral Surgery Payment Policy and the Tufts Health Plan Oral Surgery Payment Policy. |
| Modifiers | 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 | 12/1/2025 | Integrated Point32Health Payment Policy replaces the Harvard Pilgrim Health Care CPT and HCPCS Level II Modifiers Payment Policy and the Tufts Health Plan Modifiers Payment Policy. |
| Sleep Studies | Harvard Pilgrim Health Care Commercial | 12/1/2025 | Policy archived. Refer to the Evolent Clinical Guidelines for additional information. |
| Sleep Studies and Sleep Therapies | 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 | 12/1/2025 | Policy archived. For more information, refer to the EviCore Clinical Guidelines for Tufts Health Plan Commercial and Public Plan members and to our Medical Necessity Guidelines for Tufts Health RITogether members. |
| 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 | 12/1/2025 | Minor administrative edits for accuracy and clarity.
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| Urine Drug Testing | 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 | 12/1/2025 | Minor administrative edits for accuracy and clarity.
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| Physical, Occupational, and Speech Therapy | 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 | 12/1/2025 | Integrated Point32Health Payment Policy replaces the Harvard Pilgrim Health Care Physical, Occupational, and Speech Therapy Payment Policy and the Tufts Health Plan Physical, Occupational, and Speech Therapy Payment Policy. |
| Assisted Reproductive Technology | Harvard Pilgrim Health Care Commercial, Tufts Health Plan Commercial, Tufts Health Direct | 12/1/2025 | Integrated Point32Health Payment Policy replaces the Harvard Pilgrim Health Care Infertility Services Payment Policy and the Tufts Health Plan Assisted Reproductive Technology (ART) Payment Policy. |
| Home Infusion 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 | 12/1/2025 | Integrated Point32Health Payment Policy replaces the Harvard Pilgrim Health Care Home Infusion Therapy Payment Policy and the Tufts Health Plan Home Infusion Payment Policy. |
| Outpatient Behavioral Health & Substance Use Disorder | Tufts Health Together | 12/1/2025 | Updated policy to include billing guidance for peer recovery coach and peer recovery support navigator services for pregnant and post-partum women, as well as behavioral health urgent care (BHUC) services provided via telehealth. |
| Long-Term Support Services (LTSS) | Tufts Health RITogether | 12/1/2025 | Updated policy to include direction to Home Health Care Payment Policy for certain long-term support services. |
Inpatient and Intermediate/Diversionary Behavioral Health/Substance Use Disorder (BH/SUD) Facility (Tufts Health Public Plans) Inpatient and Intermediate Behavioral Health/Substance Use Disorder Facility Payment Policy (Senior Products) | Tufts Health One Care, Tufts Health Together, Tufts Health Plan Senior Care Options | 11/1/2025 | Updated policies to reflect coverage and billing guidance for Program of Assertive Community Treatment (PACT) services, and to apply to Tufts Health Plan Senior Care Options. |