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Harvard Pilgrim Health CareCommercial · Billing Codes · Reimbursement · Psychiatry, OB-GYN, Dermatology +2 moreHigh impact

Point32Health Payment Policy updates

Act
by Jun 30, 2026
Effective date
Jul 1, 2026
Identified
Jul 2, 2026

Summary

Point32Health issued multiple payment policy updates effective 7/1/2026 affecting eight service categories across Harvard Pilgrim and Tufts Health plans. Most updates are minor administrative clarifications, but two require immediate billing changes: (1) Behavioral Health now prohibits billing psychological test codes (96130-96131) and neuropsychological test codes (96132-96133) together in the same episode of care—providers must select only the predominant service code; (2) Obstetrics/Gynecology (Tufts Health RITogether only) now allows doula service billing using specific HCPCS codes (S9445, S9446, 59510, 59400) with modifiers instead of S9445 alone.

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What to do

by Jun 30, 2026 · 9 steps
01Billing team must update billing software rules to prevent simultaneous billing of CPT codes 96130-96131 (psychological evaluation) and 96132-96133 (neuropsychological evaluation) in the same episode of care for all affected Harvard Pilgrim and Tufts Health commercial products.
02Add validation logic to flag claims containing both code families and reject during pre-submission review.
03Notify behavioral health providers of the change and clarify that only the predominant service code should be billed.
04For Tufts Health RITogether plans only: Update OB/GYN billing guidance to require use of HCPCS codes S9445 (prenatal doula), S9446 (postnatal doula), 59510 or 59400 (delivery attendance) with appropriate modifiers (FP, TH, XU) instead of billing S9445 with modifiers.
05Configure system to accept these specific code combinations.
06Distribute updated billing guidelines to obstetrics/gynecology providers.
07Access the full policy details on Point32Health provider website Payment Policies section for Dermatology, Early Intervention, Emergency Department Services, Telehealth/Telemedicine, and Nutritional Counseling updates.
08Document all changes in compliance training.
09Non-compliance will result in claim denials and potential overpayment recovery.

Codes mentioned

96130961319613296133S9445S94465951059400

Original notice

Point32Health Payment Policy updates
point32health.org · Always check the source before changing claims.
View original ↗

Related changes

See all Harvard Pilgrim Health Care changes →
Billing for psychological and neuropsychological testingHighNo effective date · ReimbursementUpdate: Telehealth flexibilities for Medicare membersHighEffective Oct 1, 2025 · Provider NewsletterPoint32Health Payment Policy updatesHighEffective Nov 1, 2026 · ReimbursementPoint32Health Payment Policy updatesMediumEffective Oct 1, 2026 · ReimbursementBrowse every Harvard Pilgrim Health Care change in the policy list

Related policy hubs

Harvard Pilgrim Health Care policiesPsychiatryOB-GYNDermatologyPediatricsEmergency MedicineCode 96130Code 96131Code 96132Code 96133Code S9445Code S9446Code 59510Code 59400

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