A newsletter for Highmark Blue Cross Blue Shield providers in western New York
Issue 7, July 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
Code 0884T was added to the “Group 14: Esophagoscopy – Endo Base Procedure 43200” section of this policy. Code 0885T was added to the “Group 23: Colonoscopy through Rectum – Endo Base Procedure 45378” section. Code 0886T was added to the “Group 22: Sigmoidoscopy – Endo Base Procedure 45330” section.
RP-007 Multiple Procedure Payment Reduction for Certain Diagnostic Imaging Procedures
Codes 0876T, 0897T, and 0898T were added to this policy.
RP-011 Procedure Codes Not Applicable to Commercial Products
Codes G5019 – G5031 will be added to this policy.
RP-042 Global Surgery and Subsequent Services
Codes 0867T and 0888T were added to the “Services Assigned CMS Global Days Indicator YYY” sections of this policy for Medicare Advantage and Commercial.
RP-051 Multiple Procedure Payment Reduction for Therapy Services
In the previous version of RP-051, New York was marked in error as being an applicable Medicare Advantage market. The policy was updated on July 25, 2024, to correct this and it was removed from the NY PRCs.
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 Gene and Cellular Therapies.”
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.)
