A newsletter for Highmark Blue Cross Blue Shield providers in western New York
Issue 4, April 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-006 Multiple Endoscopy Procedures
New York Commercial products are being applied to this policy direction effective 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.
MRP-007 Modifiers CO and CQ
The reimbursement rate percentage was changed from 85% to 88%.
RP-057 Evaluation & Management Services
Medicare Advantage was made applicable to this policy, and a Medicare Advantage section was added to clarify direction that Centers for Medicare & Medicaid Services (CMS) guidelines are followed for Evaluation and Management services.
RP-009 Modifiers 25, 59, XE, XP, XS, XU, and FT
This policy was reviewed as part of our standard review process. No changes in direction were made.
RP-012 Rigid Immobilization
This policy was reviewed as part of our standard review process. No changes in direction were made.
RP-013 Electrocardiogram and Medical Imaging Interpretation
This policy was reviewed as part of our standard review process. No changes in direction were made.
RP-041 Services Not Separately Reimbursed
Code 76140 will be added and will no longer be a separately reimbursed service.
RP-006 Multiple Endoscopy Procedures
New York Medicare Advantage products are being applied to this policy direction effective 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.
RP-068 Mid-Level Practitioners and Advanced Practice Providers
This policy will be updated to include the new licensed associate marriage and family therapist (LAMFT) and licensed associate professional counselor (LAPC) specialties. It will also be restructured for clarity purposes.
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.)
RP-053 Gene and Cellular Therapy
This policy will be updated with new drugs and therapies, as well as cross-references to medical policies. The name of RP-053 will change from “Gene and Cellular Therapy” to “Advanced Therapies (Gene Therapy and Cellular Immunotherapy).”
