All PlansBilling CodesMedium impact
Reminders regarding required billing of modifiers
Harvard Pilgrim Health Care·Oncology, Nephrology, Nuclear Medicine +1 more·Reimbursement
We identified it
Jun 20, 2026
Summary
Point32Health now requires specific modifiers for three billing scenarios: drug administration routes (JA/JB), erythropoiesis-stimulating agents for renal disease (EA/EB/EC), and PET scans for oncology (PI/PS). Failure to append these required modifiers will result in claim denials.
Action Required
Immediately: Update billing system to require modifiers JA (IV) and JB (subcutaneous) for drugs with multiple administration routes. Add modifiers EA, EB, EC for ESA billing in renal patients based on treatment type. Require modifiers PI (initial) and PS (subsequent) for PET scans with oncology diagnoses. Train billing staff on proper modifier selection. Claims will be denied without appropriate modifiers.