New and Updated Reimbursement Policies

Highmark regularly issues new or updated reimbursement policies. Keep an eye on the Provider Resource Center homepage for eBulletins announcing new policies and the Reimbursement Policy page for policy updates.

Some recent changes include:

Reimbursement Policy Name Description of Change Date of Publication
RP-006: Multiple Endoscopy Procedure code 42975 was added to the endoscopy family group 10 with base code 31575. January 3, 2022
RP-007: Multiple Payment Reduction Certain Diagnostic Services Added the following Procedure Codes to Appendix A and C:
  • Appendix A: Procedure codes 0689T and 0697T
  • Appendix C: 0683T, 0684T, and 0685T
 January 3, 2022
RP-009: Modifiers 25, 59, XE, XP, XS, XU, FT Added the following guidance for modifier FT:
  • Modifier FT can be used in the same instances as modifier 25
  • Exceptions are outlined in each policy.
 January 3, 2022
RP-020: Preventive Medicine and Office/Outpatient E&M Services January 10, 2022
RP-021: Annual Gynecological and Rectal Exams January 3, 2022
RP-027: Hemodialysis and Peritoneal Dialysis  January 3, 2022
RP-028: Insertion and Removal of Tympanic Ventilation Tubes January 3, 2022
RP-032: Pain Management January 3, 2022
 RP-058: Acupuncture billed with an Evaluation Management January 3, 2022
RP-010: Incident To Billing Added the following guidance for modifier FR:
  • Modifier FR can be used when the Supervising Practitioner was present through the use of a two-way, audio/video communication technology.
 January 3, 2022
RP-011: Procedure Codes N/A to Commercial Products Added the following procedure codes to this policy:
  • G0028
  • G0029
  • G0048
  • G0049
  • G0051-G0067
  • G1024-G1028
  • G4001-G4038
  • G9988-G9999
  • M1072-M1089
  • M1094-M1105
 January 3, 2022
RP-022: Repeat Surgical Procedures Procedure code 33470 was removed. January 3, 2022
RP-025: Implantation of Subcutaneous Intravascular Catheter January 3, 2022
RP-034: Prolonged Detention or Critical Care Direction for modifiers FT and FS were added (see specifics above) and the following procedure codes were removed:
  • 93561
  • 93562
 January 3, 2022
RP-042: Global Surgery and Subsequent Services Direction for modifier FT was added (see specifics above). Added the following procedure codes to the YYY 10-day post-op listing and YYY 90-day post-op listing:
  • 10-day post-op listing: 0673T and 0699T
  • 90-day post-op listing: 0671T, 0672T, 0674T, 0675T, 0677T, 0679T, 0680T, 0681T, 0682T, and 0686T
 		 January 3, 2022
RP-043: Care Management January 3, 2022
RP-046: Telemedicine and Telehealth Services Added direction for modifiers FQ, FR, and 93 as well as for place of service 10. For information on the exact changes, review the policy. January 3, 2022
RP-053: Gene and Cellular Therapy Procedure code C9081 was removed and procedure code Q2055 was added to the policy. January 3, 2022
RP-065: Modifier Reduction Glossary Added the following modifiers to the policy:
  • CO
  • CQ
  • FQ
  • FR
  • FS
  • FT
  • 93
 January 3, 2022

To access Highmark reimbursement policy bulletins, select CLAIMS, PAYMENT & REIMBURSEMENT from the Provider Resource Center main menu, and then click on REIMBURSEMENT POLICY.

 

esubscribe