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Harvard Pilgrim Health CareCommercial · Coverage · Reimbursement · Pain Management, Pharmacy, Psychiatry +1 moreMedium impact

Reminders on pain management and opioid antagonists

Act
immediately
Effective date
Not stated in the notice
Identified
Jul 9, 2026

Summary

Point32Health issued a reminder policy on pain management and opioid antagonist coverage. The policy emphasizes coverage of non-opioid alternatives (acupuncture, physical therapy, behavioral therapy, chiropractic) and clarifies billing for opioid antagonists (naloxone and naltrexone), noting that naloxone reimbursement may occur as part of bundled rates using specific HCPCS codes. Billing teams must ensure correct coding and follow applicable formularies and Provider Manuals.

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What to do

immediately · 5 steps
01Billing team must verify current billing practices for naloxone (J0571-J0575) and naltrexone (J2310-J2311) to confirm compliance with bundled rate requirements.
02Review the applicable Point32Health formulary and Pharmacy Medical Necessity Guidelines to understand coverage criteria for opioid antagonists.
03Ensure providers are aware that naloxone reimbursement may be bundled and should not be billed separately in those cases.
04Update internal billing guidelines to reflect that pain management plan services (acupuncture, physical therapy, behavioral therapy, chiropractic) are covered alternatives.
05Providers should reference the Point32Health Provider Manual for current claims and billing guidance for opioid antagonist claims.

Codes mentioned

J0571J0572J0573J0574J0575J2310J2311

Original notice

Reminders on pain management and opioid antagonists
point32health.org · Always check the source before changing claims.
View original ↗

Related policy hubs

Harvard Pilgrim Health Care policiesPain ManagementPharmacyPsychiatryEmergency MedicineCode J0571Code J0572Code J0573Code J0574Code J0575Code J2310Code J2311

Summaries are AI-assisted. Always confirm against the original payer notice.

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