CommercialBilling CodesHigh impact
Updated billing requirements effective Jan. 1, 2026
Harvard Pilgrim Health Care·Urology, Cardiology, Internal Medicine +1 more·Reimbursement
Effective date
Jan 1, 2026
We identified it
Jun 20, 2026
Summary
Effective January 1, 2026, Harvard Pilgrim Health Care Commercial plans will deny claims for specific procedure codes unless proper diagnosis codes are also submitted. Claims for procedure codes 64561, 64581, or A4290 require a diagnosis of urinary or fecal incontinence, and ambulatory blood pressure monitoring codes (93784-93790) require elevated blood pressure without hypertension diagnosis.
Action Required
Before January 1, 2026: Billing team must update system edits to ensure claims with CPT codes 64561, 64581, or A4290 include appropriate incontinence diagnosis codes, and CPT codes 93784-93790 include elevated blood pressure diagnosis without hypertension. Update encounter forms and provider documentation requirements. Claims submitted without proper diagnosis code pairings will be denied by Harvard Pilgrim Commercial plans.