CommercialBilling CodesMedium impact
Point32Health Payment Policy updates
Harvard Pilgrim Health Care·Reimbursement
Effective date
Jan 1, 2026
We identified it
Jun 20, 2026
Summary
Point32Health is implementing four policy updates effective January 1, 2026, including consolidated policies for unlisted procedure codes, new interim billing guidelines for inpatient admissions, stricter requirements for CPT 85060 billing, and updated early intervention coding requirements.
Action Required
By January 1, 2026: Billing team must update systems to ensure CPT code 85060 (PC/TC 8) is only billed with place of service code 21 (inpatient hospital) - claims will be denied without POS 21. Update early intervention billing to use T1015-TL for applied behavioral analysis center services. Review and implement new consolidated unlisted procedure code policies and interim billing procedures for applicable Tufts health plans.