Harvard Pilgrim Health Care Home
  Learn more.
  Sign up for HPHConnect.
Medical Management
For Your Patient
News Center
Network Matters
Newsletter Archives
Newsletter Registration
Office Support
Provider Manual
Medicare Advantage
Research & Teaching
Resources & Links
Print    Text Size

Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

September 2018

Update to Radiology Payment Policy

Harvard Pilgrim is updating our commercial Radiology Payment Policy, effective for dates of service beginning Nov. 1, 2018.

Consistent with other policies, the Radiology policy will define “same” provider as a physician or other health care professional within the same billing group (reporting the same federal tax identification number [TIN]), unless the provider specialty or subspecialty is different. If multiple providers using the same TIN and of the same specialty provide radiology services to the same patient on the same date of service, Harvard Pilgrim will apply a multiple procedure payment reduction to the lower allowable radiological service (this includes bilateral services). This reduction will be 50% for global and technical (TC modifier) services, and 25% for professional (modifier 26) services. 

For more information, please refer to Harvard Pilgrim’s updated Radiology Payment Policy. Additionally, a similar change was communicated in the the November 2017 issue of Network Matters regarding our commercial Evaluation & Management Payment Policy.

Email this article to a colleague   

Network Matters Archives

Download printer-friendly version


New Product Offerings Focused on Millennials

Credentialing for Addiction Medicine


GIC Plans: Express Scripts Manages Certain Medical Drugs

Advance Care Planning Coverage

Update: Medical Review Criteria

Criteria Updates for Soliris, Prolia, and Kymriah

Medicare Advantage: Chronic Care Improvement Program for Hypertension


Billing Diagnosis Codes for Preventive Services

Update to Radiology Payment Policy

Appropriate Coding for Urine Drug Testing

Correct ICD-10-Clinical Modification Coding

New Resource for Reading Provider Adjustments in EOP

New Details in Claims Rejections for Member Information


Robert Farias,
Senior Vice President, Corporate Network Strategy

Annmarie Dadoly,

Joseph O'Riordan,

Kristin Edmonston,
Production Coordinator