Reimbursement Policies

Highmark's reimbursement policies address claims reimbursement logic as opposed to clinical information, which is addressed on medical policy. Each reimbursement policy includes information pertaining to all Highmark markets as indicated in the header, with state specific variations indicated within the policy bulletin.

Reimbursement policies are applicable to all Highmark markets, unless otherwise noted.

Highmark will outline recent changes made to reimbursement policies in each edition of our Provider News. Click below to view them.

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Policy List

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Disclaimer

Reimbursement policies are intended to reflect Highmark's coding & reimbursement guidelines. Coverage for services may vary for individual members, based on the terms of the benefit contract.

Highmark retains the right to review and update the reimbursement policy guidelines at its sole discretion. These guidelines are the proprietary information of Highmark. Any sale, copying, or dissemination of the reimbursement policies is prohibited; however, limited copying of reimbursement policies is permitted for individual use.

Acknowledgement

The five-digit numeric procedure codes and two-digit numeric modifiers that appear on the reimbursement policies on this website were obtained from the Physician's Current Procedural Terminology Manual, ^©American Medical Association. Reimbursement policies on this website also contain five-digit alphanumeric procedure codes and two-digit alphanumeric modifiers created by the Centers for Medicare and Medicaid Services.