Highmark maintains a Preventive Schedule* for members that is intended to help them get the most out of their preventive care benefits — everything from regular physicals to specific screenings for members who are at risk of certain chronic or serious health conditions.
Highmark has added the Shingrix vaccine (Procedure Code 90750) as a preventive benefit for individuals age 50 and older.
Members who received the Zoster vaccine are eligible for Shingrix as long as it has been two months or more since they received Zoster.
Note: For Medicare Advantage members, Shingrix is covered under their Medicare Part D (prescription drug) benefits.
To access the preventive health guidelines, visit the Provider Resource Center via NaviNet® or through our main website under Helpful Links. Choose Education/Manuals and Clinical Practice and Preventive Health Guidelines.
We encourage you to consult our preventive health guidelines when planning care for your patients with Highmark coverage, and we thank you for your support in addressing their health needs!
*Please note that most, but not all, of our customer groups follow the Highmark Preventive Schedule, meaning not all members may have coverage for services on the schedule. Therefore, when providing services for our members, please remember to check the member’s benefits via NaviNet or by using the appropriate HIPAA electronic transactions to determine if services are covered and if any associated member cost sharing applies. (If you do not have access to NaviNet, please call Provider Service to obtain benefits and eligibility information.) The administration of any vaccination is subject to the recommendation of the physician or other health professional. The Preventive Schedule only recommends procedures and testing.