A newsletter for Highmark Blue Shield providers in central Pennsylvania, the Lehigh Valley, northeastern Pennsylvania, and southeastern Pennsylvania
Issue 5, May 2024
New and Updated Reimbursement PoliciesHighmark regularly issues new or updated reimbursement policies. Keep an eye on this newsletter and the Provider Resource Center (PRC) homepage for announcements regarding upcoming policy changes. As specific policy changes go into effect, the updated policies can be found on the Reimbursement Policy page of the PRC.
Below is a list of recent and upcoming updates to reimbursement policies (RPs):
RP-026 Portable Radiography and ECG Services – Modifiers UN, UP, UQ, UR, US
Direction for “U” modifier reductions reported with code R0075 will be made applicable for Commercial.
RP-068 Mid-Level Practitioners and Advanced Practice Providers
This policy will be updated to include the new licensed associate marriage and family therapist (LAMFT) and licensed associate professional counselor (LAPC) specialties for Delaware and Pennsylvania. It will also be restructured for clarity purposes.
NEW: RP-077 Intraoperative Neurophysiological Monitoring
Highmark has created RP-077 to provide direction on reimbursement for Intraoperative Neurophysiological Monitoring (IONM) services. (NOTE: This policy will be available on the PRC on the effective date of June 24, 2024.)
RP-053 Gene and Cellular Therapy
This policy will be updated with new drugs and therapies, as well as cross-references to medical policies. The name of RP-053 will change from “Gene and Cellular Therapy” to “Advanced Gene and Cellular Therapies.”
