New and Updated Reimbursement Policies

Highmark Blue Cross Blue Shield of Western New York regularly issues new or updated reimbursement policies. Keep an eye on the Provider Resource Center homepage for eBulletins announcing new policies and the Reimbursement Policy page for policy updates.

Some recent Reimbursement Policies (RP) that have been updated and should be reviewed include:

• RP-002 – Co-Surgery
• RP-010 – Incident To Billing Services and Advanced Practice Provider Reductions
• RP-014 – Bilateral and Multiple Surgical Procedures
• RP-016 – Physician Laboratory and Pathology Services
• RP-017 – Evocative or Suppression Testing Panels
• RP-018 – Myocardial Perfusion SPECT Imaging
• RP-020 – Preventive Medicine and Office/Outpatient Evaluation and Management Services
• RP-024 – Eye Procedures Done in Stages or Sessions
• RP-035 – Correct Coding Guidelines
• RP-038 – Out of Network Services
• RP-053 – Gene and Cellular Therapy (CAR-T)
• RP-064 - Government Supplied Vaccinations and Antibody Treatments

*Providers must access via NaviNet .

To access Highmark reimbursement policies, select CLAIMS, PAYMENT & REIMBURSEMENT from the Provider Resource Center main menu, and then click on Reimbursement Policy.