New and Updated Reimbursement Policies
Highmark regularly issues new or updated reimbursement policies. Keep an eye on the Provider Resource Center (PRC) homepage for Special Bulletins announcing upcoming policy changes and the Reimbursement Policy page for specific policy updates.
Below is a list of upcoming and recently updated Reimbursement Policies (RP) and Medicare Advantage Reimbursement Policies (MRP):
— Updates to these RPs will become effective on January 1, 2023
, but will be published early due to the New Year’s Day holiday.
- MRP-004 Prolonged Services Codes 99356 and 99357 were deleted and removed from this policy.
- RP-003 Drug Wastage and Convenience Kits Modifier JZ was added to the policy for reference.
- RP-006 Multiple Endoscopy Procedures Codes 43290 and 43291 are being added to endoscopy family group 15 (endoscopy base code 43235) with an effective date of January 1, 2023.
- RP-011 Procedure Codes Not Applicable to Commercial Products Code G0323 is being added to this policy effective January 1, 2023.
- RP-020 Preventive Medicine and Office or Outpatient Evaluation and Management Services This policy will be applicable to New York Medicare Advantage. New York permits providers to bill for both an Annual Wellness Visit and Routine Physical on the same date of service. When Annual Wellness Visits are performed on the same date of service as a routine physical exam, the Plan will reimburse the Annual Wellness Visit at 100% and the routine physical at 50% of the approved allowed amounts.
- RP-027 Hemodialysis and Peritoneal Dialysis Codes 99217, 99218, 99219, 99220, 99241, 99251, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, and 99343 are being deleted effective December 31, 2022, and therefore, being removed from the policy effective January 1, 2023.
- RP-041 Services Not Separately Reimbursed Codes 15850 and 99340 are being removed from the policy.
- RP-042 Global Surgery and Subsequent Services Codes 0163T, G2170, and G2171 were removed, while codes 0739T, 0744T, 0745T and 0775T were added to the global YYY code sections for MA and Commercial.
- RP-043 Care Management A note is being added to this policy for new code G0323 to instruct on the use with MA only.
- RP-064 Government Supplied Vaccinations and Antibody Treatments New vaccine administration code 0104A is being added to this policy with an effective date of January 1, 2023.