New and Updated Reimbursement Policies

Highmark 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):


June 1, 2024  

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.

June 24, 2024

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.)


July 1, 2024

RP-006 Multiple Endoscopy Procedures
Code 0884T will be added to the “Group 14: Esophagoscopy – Endo Base Procedure 43200” section of this policy. Code 0885T will be added to the “Group 23: Colonoscopy through Rectum – Endo Base Procedure 45378” section. Code 0886T will be added to the “Group 22: Sigmoidoscopy – Endo Base Procedure 45330” section.

RP-011 Procedure Codes Not Applicable to Commercial Products
Codes G5019 – G5031 will be added to this policy.

August 8, 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.”


Effective Date to Be Determined

NEW: RP-076 Medical Nutrition Therapy
This new policy will direct the plan’s reimbursement for Medical Nutrition Therapy (MNT) codes 97802, 97803, 97804, G0270, and G0271 for Commercial and Medicare Advantage plans. MNT services will only be reimbursed when billed by a registered dietician or nutritional professional, or by a facility that accepts or received assignment from a registered dietician or nutritional professional. (NOTE: This policy is not yet available on the PRC.)