A newsletter for the Highmark Blue Shield providers in central Pennsylvania, the Lehigh Valley, northeastern Pennsylvania and southeastern Pennsylvania
Issue 7, July 2023
Reimbursement Updates, Including Changes to RP-026Highmark 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.
RP-026 Portable Radiography and ECG Services – Modifiers UN, UP, UQ, UR, US 
This policy will be made applicable to Medicare Advantage. Additional direction will be added for modifiers UN, UP, UQ, UR, and US when submitted with code R0075 (a transportation service code). These modifiers are also required to be included on all related claims, and the Commercial section will be updated with direction to reflect this requirement..
RP-010 Incident To Billing Services and Advanced Practice Provider Reductions
For West Virginia: West Virginia was inadvertently checked as an applicable Commercial market in the current version of RP-010. This will be corrected in the updated policy. Highmark will continue to reimburse for these services for Medicare Advantage products, as well as for Mid-Level Practitioners and Advanced Practice Providers who have been enumerated and bill using their own provider ID.*
For Pennsylvania: Incident To services for Commercial products will no longer be recognized, effective January 1, 2024. Highmark will continue to reimburse for these services for Medicare Advantage products, as well as for Mid-Level Practitioners and Advanced Practice Providers.*
For Delaware: Only non-Primary Care Physician (PCP) Incident To services will no longer be applicable to the policy, effective January 1, 2024. PCP Incident To services will still be covered. Highmark will also continue to reimburse for these services for Medicare Advantage products, as well as for Mid-Level Practitioners and Advanced Practice Providers.*
For New York: New York was inadvertently checked as an applicable Commercial market in the current version of RP-010. This will be corrected in the updated policy. Highmark will continue to reimburse for these services for Medicare Advantage products, as well as for Mid-Level Practitioners and Advanced Practice Providers who have been enumerated and bill using their own provider ID.*
*Direction for continued reimbursement for Mid-Level Practitioners and Advanced Practice Providers will be published in a new policy, RP-068 (see NEW: RP-068 further down in this article), effective on September 25, 2023.
RP-007 Multiple Procedure Payment Reduction for Certain Diagnostic Imaging Procedures
Codes 0807T and 0808T were added to the APPENDIX A – Procedure Codes Applicable To Professional And Technical Component Reduction section. Code 0804T was added to the APPENDIX B – Applicable Cardiovascular Procedure Codes section.
RP-042 Global Surgery and Subsequent Services
Codes 0793T, 0795T, 0796T, 0797T, 0798T, 0799T, 0800T, 0801T, 0802T, 0803T, 0805T, 0809T, and 0810T were added to the global YYY codes sections for Medicare Advantage and Commercial.
RP-015 Professional and Technical Components for Applicable Services
The Public Health Emergency (PHE) exception note was removed. Codes 99000 and 99001 returned to pre-PHE policy direction.
RP-016 Physician Laboratory and Pathology Services
The PHE exception note was removed. Codes 99000 and 99001 returned to pre-PHE policy direction.
RP-027 Hemodialysis and Peritoneal Dialysis
Policy exception notes pertaining to the PHE were removed. A definitions section was added.
RP-041 Services Not Separately Reimbursed
PHE exception notes and end-dated codes G2023, G2024, and U0005 were removed. Codes 99000, 99001, 90887, 99024, 99374, 99377, 99378, 99379, 99380, and 99483 returned to pre-PHE direction.
RP-046 Telemedicine and Telehealth Services
This policy was updated with post-PHE direction.
RP-054 Ambulance Services
The PHE exception note for destination requirements was removed.
RP-064 Government Supplied Vaccinations and Antibody Treatments
Direction was updated for codes 91303, 0031A, and 0034A.
RP-002 Co-Surgery
This policy was reviewed as part of our standard review process. No changes in direction were made.
RP-014 Bilateral and Multiple Surgical Procedures
This policy was reviewed as part of our standard review process. No changes in direction were made.
RP-017 Evocative or Suppression Testing Panels
This policy was reviewed as part of our standard review process. No changes in direction were made.
RP-018 Myocardial Perfusion SPECT Imaging
This policy was reviewed as part of our standard review process. No changes in direction were made.
RP-021 Annual Gynecological and Rectal Exams
This policy was reviewed as part of our standard review process. No changes in direction were made.
RP-023 Newborn Care, Obstetrical Delivery, Antepartum and Postpartum Care and Associated Services
This policy was reviewed as part of our standard review process. No changes in direction were made.
RP-025 Implantation of Subcutaneous Intravascular Catheter
This policy was reviewed as part of our standard review process. No changes in direction were made.
RP-030 Insertion of Tissue Expanders
This policy was reviewed as part of our standard review process. No changes in direction were made.
RP-032 Pain Management
This policy was reviewed as part of our standard review process. No changes in direction were made.
RP-034 Prolonged Detention or Critical Care
This policy was reviewed as part of our standard review process. No changes in direction were made.
RP-041 Services Not Separately Reimbursed
This policy will be made applicable to facility (UB) claims.
RP-019N Drugs and Biologicals
An updated version of this policy will be available for review on the PRC on August 31, 2023, and will be effective beginning September 1, 2023. Drug tiering is being eliminated for Delaware, Pennsylvania, and West Virginia. To access this reimbursement policy, log into NaviNet® and select Resource Center from the left menu. Once redirected to the PRC, select CLAIMS, PAYMENT & REIMBURSEMENT in the left menu and then click Reimbursement Policy.
NEW: RP-068 Mid-Level Practitioners and Advanced Practice Providers
Highmark has created RP-068 to provide direction on reimbursement for Mid-Level Practitioners and Advanced Practice Providers. (NOTE: This policy will be available on the PRC on September 25, 2023.)
RP-026 Portable Radiography and ECG Services – Modifiers UN, UP, UQ, UR, US
This policy will be made applicable to Medicare Advantage. Additional direction will be added for modifiers UN, UP, UQ, UR, and US when submitted with code R0075 (a transportation service code). These modifiers are also required to be included on all related claims, and the Commercial section will be updated with direction to reflect this requirement..
