CommercialReimbursementHigh impact
Reimbursement updates for preventive medicine services
Harvard Pilgrim Health Care·Family Medicine, Internal Medicine, OB-GYN +2 more·Provider Newsletter
Effective date
Jun 1, 2026
We identified it
Jun 20, 2026
Summary
Point32Health will no longer reimburse certain services separately when billed on the same day as preventive medicine visits. Services like annual gynecological exams, counseling, screening services, and other E&M services will be considered inclusive to the preventive visit, even with modifiers 25 or 59.
Action Required
Before June 1, 2026: Billing team must update system rules to prevent separate billing of annual gynecological exams, counseling, medical nutrition therapy, other E&M services, prolonged services, screening services, and visual function screenings when billed same day as preventive medicine visits (CPT 99381-99387, 99391-99397, HCPCS G0402). Update encounter forms to alert providers that these services are bundled. Train staff that modifiers 25 and 59 will not override this bundling rule for Point32Health plans.