Point32Health is updating our policy related to the reimbursement of preventive medicine services when billed with screening and/or other evaluation and management (E&M) services. Effective for dates of service beginning June 1, 2026, the items below will be considered inclusive to a preventive medicine visit and will not be reimbursed separately when billed on the same day as preventive medicine services using CPT codes 99381–99387, 99391–99397, and HCPCS code G0402. 

  • Annual gynecological examinations
  • Counseling 
  • Medical nutrition therapy 
  • Other E&M services
  • Prolonged services
  • Screening services
  • Visual function and visual acuity screenings

Appending modifiers 25 or 59 (including X- modifiers) to the services above will not result in separate reimbursement, as reimbursement is included in the overall visit.

We’ve revised our Harvard Pilgrim Health Care and Tufts Health Plan Evaluation and Management (E&M) Payment Policies to reflect this reimbursement update.

As a reminder, preventive medicine focuses on performing a patient history and examination specific to a member’s age and gender. Both initial and routine comprehensive preventive medicine examinations also encompass counseling, anticipatory guidance, and interventions aimed at reducing risk factors.