CommercialBilling CodesHigh impact
Laboratory Payment Policies: Sept. 1, 2026 updates
Harvard Pilgrim Health Care·Rheumatology, Cardiology, Gastroenterology +2 more·Reimbursement
Effective date
Sep 1, 2026
We identified it
Jul 2, 2026
Summary
Point32Health is implementing multiple CPT code additions and removals across six laboratory payment policies effective September 1, 2026. Billing teams must update coding systems to add new codes (0522U, 83876, 87140, 87270, 87285, 87320, 87494, 87660, 87810, 86141) and remove obsolete codes (0052U, 0308U, 0309U, 0415U, 0541U, 86704, 86706, 87340, G0499, 0455U, 0463U) across autoimmune rheumatic disease, cardiovascular, colorectal, STI, and pancreatic testing policies.
Action Required
By August 31, 2026: Billing team must update billing software and claims systems to implement all code changes across Harvard Pilgrim Health Care Commercial laboratory policies. ADDITIONS: Add CPT 0522U to autoimmune rheumatic disease and colorectal cancer screening policies; add CPT 83876 to cardiovascular disease risk assessment policy; add CPT codes 87140, 87270, 87285, 87320, 87494, 87660, 87810 to STI testing policy; add CPT 86141 to pancreatic enzyme testing policy. REMOVALS: Remove CPT codes 0052U, 0308U, 0309U, 0415U, 0541U from cardiovascular disease risk assessment policy; remove CPT codes 86704, 86706, 87340, G0499 from STI testing policy (migrate to Hepatitis Testing policy); remove CPT codes 0455U, 0463U from STI testing policy; remove CPT codes from all affected policies per policy document. Update encounter templates and billing rules to reflect new codes. Review redlined versions on Point32Health provider website. Failure to implement changes by effective date will result in claim denials or rejections for services billed with outdated or removed codes.