CommercialReimbursementHigh impact
Updates to Maximum Units Payment Policy
Harvard Pilgrim Health Care·Reimbursement
Effective date
May 1, 2026
We identified it
Jun 20, 2026
Summary
Effective May 1, 2026, Tufts Health Plan will adopt CMS and Medicaid maximum unit values (MUE) for all HCPCS and CPT codes, aligning with existing Harvard Pilgrim processes. Claims exceeding these maximum units will not receive additional reimbursement, though providers can appeal with supporting medical records.
Action Required
Before May 1, 2026: Billing team must review all commonly billed CPT and HCPCS codes to identify CMS and Medicaid MUE limits. Update billing system edits to flag claims exceeding maximum units. Train staff on appeal process with medical records for cases requiring units above MUE limits. Review historical claims to identify codes frequently billed above standard limits and prepare documentation protocols.