Update to Non-Covered Services

As of Jan. 1, 2022, Harvard Pilgrim has added the following recently released codes to our New Technology Assessment and Non-Covered Services Medical Policy, and they will be considered non-covered:

0285U 0286U 0289U
0290U 0291U 0292U
0293U 0294U 0296U
0297U 0298U 0299U

In addition, effective for dates of service beginning March 1, 2022, we are adding the following codes to the policy, which will be considered experimental/investigational and will no longer be covered as of that date:

K1021 K1023 K1024
K1025 K1027 Q4251
Q4252 Q4253 0258U
0260U 0262U 0264U
0265U 0266U 0267U
0268U 0269U 0270U
0271U 0272U 0273U
0274U 0276U 0277U

For complete details, please refer to the updated New Technology Assessment and Non-Covered Services Medical Policy.

Publication Information

Audrey Kleinberg,
Director, Provider Relations & Communications

Annmarie Dadoly,

Joseph O’Riordan,

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Production Coordinator