Reimbursement Policy

Archived Policies

Highmark's reimbursement policies address claims reimbursement logic as opposed to clinical information, which is addressed on medical policy. Each reimbursement policy includes information pertaining to all Highmark markets as indicated in the header, with state specific variations indicated within the policy bulletin.

Effective July 6, 2021, Medicare Advantage reimbursement policies will be published on this page. Policies specific to Medicare Advantage will have a reimbursement policy number that begins with MRP. Check each individual policy to confirm which market it pertains to.

History versions of reimbursement policies are stored within the PDF files. Click the "View History" link on the first page of the policy to view previous versions.

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Disclaimer
Reimbursement policies are intended to reflect Highmark's coding & reimbursement guidelines. Coverage for services may vary for individual members, based on the terms of the benefit contract.
Highmark retains the right to review and update the reimbursement policy guidelines at its sole discretion. These guidelines are the proprietary information of Highmark. Any sale, copying or dissemination of the reimbursement policies is prohibited; however, limited copying of reimbursement policies is permitted for individual use.
Acknowledgement
The five-digit numeric codes that appear on the reimbursement policies on this web site were obtained from the Physician's Current Procedural Terminology Manual, © American Medical Association.
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