A newsletter for Highmark Blue Cross Blue Shield providers in West Virginia
Issue 8, August 2024
New and Updated Reimbursement PoliciesHighmark 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):
RP-053 Advanced Gene and Cellular Therapies
This policy was updated with new drugs and therapies, as well as cross-references to medical policies. The name of RP-053 changed from “Gene and Cellular Therapy” to “Advanced Gene and Cellular Therapies.”
RP-068 Mid-Level Practitioners and Advanced Practice Providers
Licensed clinical social workers (LCSWs) may have noticed an increased reimbursement percentage identified in a June 1, 2024, update to RP-068. Effective Aug. 16, 2024, that percentage will return to its previous rate (75%). For more information, read our Special Bulletin.
RP-057 Evaluation & Management Services
A “Definitions” section will be added to this policy. In addition, the total time requirements for codes 99202-99205 (new patient services) and the total minutes requirements for codes 99212-99215 (established patient services) and codes 99306-99308 (nursing facility services) will be updated.
RP-054 Ambulance Services
Direction from Medicare Advantage (MA) Medical Policy T-2 (Ground Ambulance) will be transferred to RP-054, which will become applicable to MA effective Oct. 28, 2024. There will be no changes to the MA direction.
NEW: RP-076 Medical Nutrition Therapy
This new policy will direct the plan’s reimbursement for Medical Nutrition Therapy (MNT) codes 97802, 97803, 97804, G0270, and G0271 for Commercial and Medicare Advantage plans. MNT services will only be reimbursed when billed by a registered dietician or nutritional professional, or by a facility that accepts or received assignment from a registered dietician or nutritional professional. (NOTE: This policy is not yet available on the PRC.)
