Effective Nov. 1 2024, Highmark is increasing the Daily Dollar Maximum (DDM) for most therapy services in the Western New York and Northeastern New York regions.

For physical therapy (PT) and occupational therapy (OT) services, the DDM rate is increasing for both Commercial and Medicare Advantage lines of business. For Chiropractic Services, the DDM is increasing for Commercial and remaining the same for Medicare Advantage. See the rates below:

Therapy Services	Current Rate	New Rate
Commercial PT / OT	$48.21	$81.61
Medicare Advantage PT / OT	$45.68	$80.34
Commercial Chiropractic	$40.60	$82.83
Medicare Advantage Chiropractic	$40.60	$40.60

What This Means to You

While the fee schedule will be applied on all services, claims will only pay up to (and not exceed) the Daily Dollar Maximum for the rendering provider specialty. An initial therapy evaluation service (97161, 97162, 97163, 97165, 97166, 97167) is separately payable. Re-evaluation codes (97164, 97168) are applied to the DDM and are not separately payable. For additional information on policy guidelines, please refer to Reimbursement Policy (RP)-067 Specific Service Daily Maximum.