CommercialBilling CodesHigh impact
Point32Health Payment Policy updates
Harvard Pilgrim Health Care·Psychiatry, OB-GYN, Dermatology +2 more·Reimbursement
Effective date
Jul 1, 2026
We identified it
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.
Action Required
By June 30, 2026: (1) Billing 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. Add validation logic to flag claims containing both code families and reject during pre-submission review. Notify behavioral health providers of the change and clarify that only the predominant service code should be billed. (2) For 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. Configure system to accept these specific code combinations. Distribute updated billing guidelines to obstetrics/gynecology providers. (3) Access the full policy details on Point32Health provider website Payment Policies section for Dermatology, Early Intervention, Emergency Department Services, Telehealth/Telemedicine, and Nutritional Counseling updates. Document all changes in compliance training. Non-compliance will result in claim denials and potential overpayment recovery.