New and Updated Reimbursement Policies – April 2026
Mon, Apr 27, 2026
Highmark regularly issues new or updated reimbursement policies. Keep an eye on the Communications Hub of the Provider Resource Center (PRC) for announcements regarding upcoming policy changes. As specific policy changes go into effect, the updated policies can be found on the Reimbursement Policies page of the PRC.
Below is a list of recent and upcoming updates to reimbursement policies (RPs):
Recently Updated
April 6, 2026
RP-053 Advanced Gene and Cellular Therapies
Gene therapies Itvisma and Waskyra were added.
April 27, 2026
RP-009 Modifiers 25, 59, XE, XP, XS, XU, and FT
The After-Hours Codes section was removed from this policy, as those codes and direction were moved to RP-041 Services Not Separately Reimbursed.
RP-027 Hemodialysis and Peritoneal Dialysis
Code 90999 was removed.
RP-033 Anesthesia Services
Direction for physical status modifiers was removed.
- wny
- neny
RP-037 Emergency Evaluation and Management Coding Guidelines
This policy was made applicable to New York professional claims, which will be reviewed by Highmark when submitted for emergency department services, effective April 27, 2026. For more information, CLICK HERE. (NOTE: This policy update was previously communicated as having a Feb. 2, 2026, effective date. That effective date was pushed back to April 27, 2026.)
RP-041 Services Not Separately Reimbursed
Codes 99050, 99051, 99053, 99056, 99058, 99060, 99288, 96041, 99485, 99486, and G2211 were added. Codes 92921, 92925, 92929, 92934, and 92938 were removed.
RP-047 Venipuncture and Lab Services
Medicare Advantage direction was changed.
Upcoming
May 25, 2026
RP-043 Care Management
This policy will be updated to streamline direction and add definitions for clarity. Codes 99497 and 99498 will also be added.
RP-075 Appropriate Use Criteria for Advanced Diagnostic Imaging
This policy will be archived, effective May 25, 2026.
June 29, 2026
RP-011 Procedure Codes Not Applicable to Commercial Products
This policy will be made applicable to facility providers, effective June 29, 2026.
July 1, 2026
RP-003 Convenience Kits, Drug and Biological Wastage
The Centers for Medicare and Medicaid Services (CMS) began reimbursing non-BLA (Biologics License Application) skin substitutes as incident-to supplies at a flat national rate, effective Jan. 1, 2026. Highmark is adopting the CMS flat national rate pricing methodology for non-BLA skin substitutes – with the change taking effect July 1, 2026, for Commercial plans and retroactive to Jan. 1, 2026, for Medicare Advantage plans. For more information, CLICK HERE.
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