Reimbursement rate update for home infusion therapy

As a reminder, if you are reporting home infusion therapy services for multiple dates of service for the same Point32Health member, you should report a separate line for each date of service with the applicable procedure code(s) and number of units for that date. 

Consistent with industry standard correct coding guidelines, Point32Health requires that modifier SH (second concurrently administered infusion therapy) or SJ (third or more concurrently administered infusion therapy) be included as appropriate. Effective for dates of service beginning Dec. 1, 2025, we will reimburse subsequent concurrent infusions (identified by SH or SJ) at 50% of the standard rate/fee schedule amount for all of our Harvard Pilgrim and Tufts Health Plan members. 

For more information, please refer to our updated Harvard Pilgrim Health Care Home Infusion Therapy Payment Policy and Tufts Health Plan Home Infusion Payment Policy in the Payment Policies section of our provider website.

(Consistent with Maine regulations, a redlined version of the Harvard Pilgrim policy is also posted temporarily.)