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Harvard Pilgrim Health CareCommercial · Billing Codes · Reimbursement · OB-GYN, PathologyMedium impact

Cervical cancer screening updates

Effective date
Jan 1, 2027
Identified
Nov 6, 2026

Summary

Effective for dates of service beginning January 1, 2027, Harvard Pilgrim Health Care Commercial and Tufts Health Direct products will require modifier 33 in the first modifier field, plus one listed cervical diagnosis code in the primary position, on specified biopsy, colposcopy, dual stain, and pathology codes so those services are considered preventive under the cervical cancer screening benefit. The practice should update charge entry and claim edits to capture the modifier and diagnosis sequence for these plans before that date.

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What to do

Action · 3 steps
01Future transition 2027-01-01 (dates of service beginning on or after this date): Billing team should update charge entry and claim edits for Harvard Pilgrim Health Care Commercial and Tufts Health Direct claims so that when CPT/HCPCS 57500, 57420, 57421, 57452, 57454, 57455, 57456, 57460, 57461, 57465, 88305, or 88344 is billed, modifier 33 is placed in the first modifier field and one of the listed cervical diagnosis codes (D06.0, D06.1, D06.7, N84.1, N87.0, N87.1, N87.9, R87.610-R87.619, R87.810, R87.820) is in the primary diagnosis position.
02Providers and coders should be told the requirement so documentation supports the selected diagnosis.
03Confirm current applicability against the Harvard Pilgrim Commercial and Tufts Health Public Plans Provider Manuals updated as of January 1, 2027, since the source states these services will be considered preventive only when the modifier and diagnosis requirements are met; claims without them may be processed outside the cervical cancer screening benefit.

Codes mentioned

575005742057421574525745457455574565746057461574658830588344D06.0D06.1D06.7N84.1N87.0N87.1N87.9R87.610R87.611R87.612R87.613R87.614R87.615R87.618R87.619R87.810R87.820

Original notice

Cervical cancer screening updates
point32health.org · Always check the source before changing claims.
View original ↗

Related policy hubs

Harvard Pilgrim Health Care policiesOB-GYNPathologyCode 57500Code 57420Code 57421Code 57452Code 57454Code 57455Code 57456Code 57460Code 57461Code 57465Code 88305Code 88344Code D06.0Code D06.1Code D06.7Code N84.1Code N87.0Code N87.1Code N87.9Code R87.610Code R87.611Code R87.612Code R87.613Code R87.614Code R87.615Code R87.618Code R87.619Code R87.810Code R87.820

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