Reimbursement Policy

Archived Policies

Highmark's reimbursement policies address claims reimbursement logic as opposed to clinical information, which is addressed on medical policy. Each reimbursement policy includes information pertaining to all Highmark markets as indicated in the header, with state specific variations indicated within the policy bulletin.

History versions of reimbursement policies are stored within the PDF files. Click the "View History" link on the first page of the policy to view previous versions.

Issued: 6/2018
Effective: 8/2016
RP-001
Audience: Professional
Issued: 12/2017
Effective: 8/2016
RP-002
Audience: Professional
Issued: 11/2018
Effective: 8/2016
RP-003
Audience: All
Issued: 12/2017
Effective: 8/2016
RP-004
Audience: Professional
Issued: 1/2018
Effective: 8/2016
RP-005
Audience: Professional
Issued: 1/2018
Effective: 8/2016
RP-006
Audience: Professional
Issued: 5/2019
Effective: 1/2017
RP-007
Audience: Professional
Issued: 2/2018
Effective: 1/2017
RP-008
Audience: All
Issued: 7/2018
Effective: 2/2017
RP-009
Audience: Professional
Issued: 5/2019
Effective: 4/2017
RP-011
Audience: Professional
Issued: 10/2017
Effective: 10/2017
RP-012
Audience: Professional
Issued: 12/2017
Effective: 7/2017
RP-013
Audience: Professional
Issued: 12/2017
Effective: 10/2017
RP-014
Audience: Professional
Issued: 2/2019
Effective: 10/2017
RP-015
Audience: Professional
Issued: 1/2018
Effective: 10/2017
RP-016
Audience: Professional
Issued: 10/2017
Effective: 10/2017
RP-017
Audience: All
Issued: 12/2017
Effective: 11/2017
RP-018
Audience: Professional
Issued: 11/2018
Effective: 1/2018
RP-020
Audience: All
Issued: 1/2018
Effective: 1/2018
RP-021
Audience: All
Issued: 12/2018
Effective: 1/2018
RP-022
Audience: Professional
Issued: 1/2018
Effective: 1/2018
RP-023
Audience: Professional
Issued: 1/2018
Effective: 1/2018
RP-024
Audience: Professional
Issued: 1/2018
Effective: 1/2018
RP-025
Audience: All
Issued: 1/2018
Effective: 1/2018
RP-026
Audience: All
Issued: 1/2018
Effective: 1/2018
RP-026
Audience: All
Issued: 12/2018
Effective: 2/2018
RP-027
Audience: All
Issued: 3/2018
Effective: 3/2018
RP-028
Audience: Professional
Issued: 3/2018
Effective: 3/2018
RP-029
Audience: Professional
Issued: 3/2018
Effective: 3/2018
RP-030
Audience: Professional
Issued: 3/2018
Effective: 3/2018
RP-031
Audience: Professional
Issued: 12/2018
Effective: 3/2018
RP-032
Audience: Professional
Issued: 3/2018
Effective: 3/2018
RP-033
Audience: Professional
Issued: 5/2018
Effective: 5/2018
RP-034
Audience: Professional
Issued: 8/2018
Effective: 5/2018
RP-035
Audience: All
Issued: 6/2018
Effective: 6/2018
RP-036
Audience: Professional
Issued: 8/2018
Effective: 8/2018
RP-037
Audience: Facility
Issued: 9/2018
Effective: 11/2018
RP-038
Audience: All
Issued: 11/2018
Effective: 11/2018
RP-039
Audience: All
Issued: 9/2018
Effective: 12/2018
RP-040
Audience: All
Issued: 12/2018
Effective: 12/2018
RP-041
Audience: Professional
Issued: 12/2018
Effective: 11/2018
RP-042
Audience: Professional
Issued: 5/2019
Effective: 1/2019
RP-043
Audience: Professional
Issued: 12/2018
Effective: 12/2018
RP-045
Audience: Professional
Issued: 5/2019
Effective: 5/2019
RP-047
Audience: All

 

Disclaimer
Reimbursement policies are intended to reflect Highmark's coding & reimbursement guidelines. Coverage for services may vary for individual members, based on the terms of the benefit contract.
Highmark retains the right to review and update the reimbursement policy guidelines at its sole discretion. These guidelines are the proprietary information of Highmark. Any sale, copying or dissemination of the reimbursement policies is prohibited; however, limited copying of reimbursement policies is permitted for individual use.
Acknowledgement
The five-digit numeric codes that appear on the reimbursement policies on this web site were obtained from the Physician's Current Procedural Terminology Manual, © American Medical Association.
Current Dental Terminology. © American Dental Association. All rights reserved.
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