Medicare AdvantagePrior AuthMedium impact
Point32Health Medical Necessity Guideline updates
Harvard Pilgrim Health Care·ENT (Ear, Nose & Throat), Plastic Surgery, Wound Care +3 more·Prior Authorization
Effective date
Mar 1, 2026
We identified it
Jun 20, 2026
Summary
Point32Health is removing prior authorization requirements for several services effective March 1, 2026, including skin substitutes/bioengineered grafts for Medicare plans, CPT 30560 nasal procedures for commercial plans, and streamlining ABA therapy coverage for teens. Additionally, sickle cell gene therapy continuity of care provisions are being enhanced.
Action Required
Before March 1, 2026: Billing team must update prior authorization workflows to remove requirements for CPT 30560 (nasal synechia lysis) for Harvard Pilgrim Commercial plans and skin substitute/bioengineered graft codes for Tufts Medicare plans. Update billing system rules and staff training materials to reflect these changes.