Annual Update to Highmark’s Professional Fee Schedule

Effective October 1, 2023, Highmark will make its annual update to our standard professional fee and pricing methodology, which applies to the following Highmark service areas — Delaware, Pennsylvania, and West Virginia — for commercial lines of business. To read the Special Bulletin that was published on August 1, 2023, click here .

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Quarterly Fee Schedules

The standard professional quarterly fee schedules were published on July 25, 2023. To view them on the Provider Resource Center (PRC), log into NaviNet^® and select Resource Center from the left menu. Once you arrive at the PRC, choose CLAIMS, PAYMENT & REIMBURSEMENT from the left menu and click Fee Schedule Information.

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Hepatitis C Testing – Single-Visit Approach

The Centers for Disease Control and Prevention (CDC) recently updated its guidelines for Hepatitis C Virus (HCV) testing, moving from a two-appointment to a single-visit approach. New guidance for completion of HCV testing supports operational strategies that collect samples at a single visit, and automatic HCV RNA testing on all HCV antibody reactive samples. Use of strategies that require multiple visits to collect samples should be discontinued.

• Automatic HCV RNA testing on all HCV antibody reactive samples will increase the percentage of patients with current HCV infection who are linked to care and receive curative antiviral therapy.
• Hepatitis C tests are covered under preventive with the diagnosis code Z11.59. Encounter for screening for other viral diseases with procedure codes G0472, 86803, 86804, 87520, 87521, 87522, G0472.

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Annual SPH Analytics Survey

Over the next several weeks, SPH Analytics (an independent research firm) will be conducting a phone survey with a sample of professional providers to assess knowledge of the tools available to you and your staff to verify the products/networks in which you participate through your Highmark contract. To learn more, click here .

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Reissued Contracts Due by Sept. 15

Between July and December 2022, Highmark issued new contracts to participating physical therapists, occupational therapists, and chiropractors. Beginning on May 1, 2023, these contracts were reissued electronically to all non-respondents. If you have not done so already, please review and return your Highmark Inc. Commercial and Medicare Advantage agreements no later than September 15, 2023. To read the Special Bulletin, click here .

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Medical Policy Update Newsletter

The August newsletter is available here .