New and Updated Reimbursement Policies – August 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

Aug. 24, 2026

RP-012 Rigid Immobilization

This policy was made applicable to Medicare Advantage. Codes 29086, 29130, 29131, 29200, 29240, 29260, 29280, 29440, 29450, 29520, 29530, 29540, 29550, 29580, 29581, and 29584 were added.

Aug. 31, 2026

MRP-002 Reporting Clinical Pathology Consultation Services

MRP-002 was archived, effective Aug. 31, 2026, with policy direction moved to RP-016 Physician Laboratory and Pathology Services (see below).

RP-015 Professional and Technical Components for Applicable Services

This policy underwent an administrative review. No changes in direction were made.

RP-016 Physician Laboratory and Pathology Services

RP-016 was updated to merge Medicare Advantage direction from MRP-002 Reporting Clinical Pathology Consultation Services (see above).

RP-020 Preventive Medicine and Office/Outpatient Evaluation and Management Services

This policy underwent an administrative review. No changes in direction were made.

RP-064 Government Supplied Vaccines and Antibody Treatments

Special direction for SARS-CoV-2 vaccines and antibody treatments was removed.

Upcoming

Sept. 1, 2026

RP-046 Telemedicine and Telehealth Services

Effective Sept. 1, 2026, Highmark will update its telemedicine and telehealth policy to align with guidance from the Centers for Medicare and Medicaid Services (CMS) and American Medical Association (AMA). For more information, CLICK HERE.

Sept. 7, 2026

RP-040 Facility Routine Supplies and Services

This policy underwent an administrative review. No changes in direction will be made.

Sept. 28, 2026

RP-041 Services Not Separately Reimbursed

Codes 77387, 77417, and 77439 will be added for Commercial and Medicare Advantage. In addition, a list of Status B codes – which has already been applicable for Medicare Advantage – will be added for clarity.

RP-055 Nominal Charges

This policy underwent an administrative review. No changes in direction will be made.

NEW: RP-085 Observation Care

Aligning with the Centers for Medicare and Medicaid Services (CMS), this new policy will provide reimbursement direction for observation services when performed for eight hours or less and separately payable from emergency room billing. This policy direction will be enforced on a post-pay basis.

Oct. 26, 2026

RP-051 Multiple Procedure Payment Reduction for Therapy Services

Effective Oct. 26, 2026, Highmark will no longer allow for the separate reimbursement of code 97124 for providers designated in the following specialties: Chiropractic, Physical Therapy, Occupational Therapy, and Physiatry. To reflect this change, direction for code 97124 will be added to RP-051, applicable to Commercial and Medicare Advantage for all regions. For more information, CLICK HERE.

Nov. 1, 2026

RP-010 Incident To Services

Modifier SA will be required when reporting “incident to” services, effective Nov. 1, 2026. Direction for this requirement will be added to RP-010.