IMPORTANT: Keep Your Provider Directory Information Current to Protect Your Network Status. Learn more

Watch for Updates to Highmark’s List of Procedures Requiring Authorization

During the year, Highmark makes adjustments to the List of Procedures/DME Requiring Authorization, which includes outpatient procedures, services, durable medical equipment (DME), and drugs that require authorization for our members.

These changes are announced in the form of Special Bulletins that are posted on our online Provider Resource Center (PRC). These Special Bulletins are communicated as Hot Topics on the PRC and are archived under Newsletters/Notices > Special Bulletins & Mailings.

The list includes services such as:

  • Potentially experimental, investigational, or cosmetic services
  • DME
  • Select injectable drugs
  • Oxygen
  • Not Otherwise Classified (NOC) procedure codes
  • Certain outpatient procedures, services, and supplies

To search for a specific procedure code within the List of Procedures/DME Requiring Authorization, press the Control and “F” keys on your computer keyboard, enter the procedure code, and press Enter.

For up-to-date information on procedures that require authorization or to view the current list of procedure codes, visit the PRC, accessible via Highmark NaviNet® or under Helpful Links on our website.

Remember, the Highmark member must be eligible on the date of service, and the service must be a covered benefit in order for Highmark to pay your claim.

You may use NaviNet or the applicable HIPAA electronic transactions to:

  • Check member benefits and eligibility
  • Verify if an authorization is needed
  • Obtain authorization for services

If you don’t have NaviNet or access to the HIPAA electronic transactions, please call Clinical Services to obtain authorization for services.

 

esubscribe