New and Updated Reimbursement Policies

Highmark 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.

Below is a list of recent and upcoming updates to reimbursement policies (RPs):


March 11, 2024

RP-065 Modifier Reduction Glossary
New modifiers FX, FY, UN, UP, UQ, UR, US, and 56 were added, along with information on their purpose and associated policies.

March 18, 2024

MRP-005 Repairs, Maintenance, and Replacement of Durable Medical Equipment
Effective March 18, 2024, this policy was archived. The direction of this policy was merged into a new version of RP-069 (see below), which went into effect March 18, 2024.

RP-035 Correct Coding Guidelines
The American Medical Association’s (AMA) Current Procedural Terminology (CPT) Assistant was added to the list of guidelines and resources in the “Reimbursement Guidelines” section of this policy.

RP-069 DME Maintenance, Repair, and Replacement
This policy was updated to include Medicare Advantage direction merged from MRP-005 (see above).


April 1, 2024

RP-034 Prolonged Detention or Critical Care
Code 93598 will be added to the “Prolonged Detention or Critical Care” section of this policy.

April 29, 2024

RP-041 Services Not Separately Reimbursed
Code 76140 will be added and will no longer be a separately reimbursed service.

May 1, 2024

RP-026 Portable Radiography and ECG Services – Modifiers UN, UP, UQ, UR, US
Direction for “U” modifier reductions reported with code R0075 will be made applicable for Commercial.

June 24, 2024

NEW: RP-077 Intraoperative Neurophysiological Monitoring
Highmark has created RP-077 to provide direction on reimbursement for Intraoperative Neurophysiological Monitoring (IONM) services. (NOTE: This policy will be available on the PRC on the effective date of June 24, 2024.)