CommercialReimbursementMedium impact
Reimbursement rate update for home infusion therapy
Harvard Pilgrim Health Care·Oncology, Infectious Disease, Gastroenterology +1 more·Reimbursement
Effective date
Dec 1, 2025
We identified it
Jun 20, 2026
Summary
Point32Health (Harvard Pilgrim and Tufts Health Plan) will reduce reimbursement for concurrent home infusion therapy services to 50% of standard rates when using modifiers SH or SJ. The policy emphasizes proper coding requirements for multiple concurrent infusions and separate billing lines for each date of service.
Action Required
Before December 1, 2025: Billing team must update fee schedules in billing system to reflect 50% reimbursement rates for Point32Health members when using modifiers SH (second concurrent infusion) and SJ (third or more concurrent infusions). Review current home infusion therapy billing procedures to ensure separate lines are reported for each date of service with appropriate modifiers. Update financial counseling protocols to inform patients of potential reduced coverage for concurrent infusions.