New and Updated Reimbursement Policies – February 2026
Mon, Feb 23, 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
Feb. 2, 2026
RP-011 Procedure Codes Not Applicable to Commercial Products
Code G0071 was removed.
Feb. 23, 2026
RP-041 Services Not Separately Reimbursed
Codes 76376 and 76377 were added to this policy as not separately reimbursed for Commercial and Medicare Advantage.
NEW: RP-084 Remote Patient Monitoring
The purpose of this new policy, effective Feb. 23, 2026, is to get in front of cost and utilization trends around this growing service. This new policy direction clarifies when and how remote patient monitoring (RPM) should be used and when it will be reimbursed by the plan. It provides guidelines on RPM usage by providers and reimbursement for RPM-specific Current Procedural Terminology (CPT) codes.
Upcoming
- wpa/ nepa
- cpa/ sepa
- de
- wny
- neny
March 2, 2026
RP-068 Mid-Level Practitioners and Advanced Practice Providers
This policy will be updated to include the certified registered nurse anesthetist (CRNA) specialty, which will be reimbursed at 85% of the fee schedule allowance for Commercial, effective March 2, 2026.
- wpa/ nepa
- cpa/ sepa
- de
- wv
March 30, 2026
RP-004 Modifiers 52 and 53
This policy will be made applicable to Medicare Advantage.
RP-037 Emergency Evaluation and Management Coding Guidelines
This policy will be made applicable to Delaware, Pennsylvania, and West Virginia professional claims, which will be reviewed by Highmark when submitted for emergency department services, effective March 30, 2026. For more information, CLICK HERE. (NOTE: This policy update was previously communicated as having a Feb. 2, 2026, effective date. That effective date has been pushed back to March 30, 2026.)
April 27, 2026
RP-009 Modifiers 25, 59, XE, XP, XS, XU, and FT
The After-Hours Codes section will be removed from this policy, as those codes and direction will be moved to RP-041 Services Not Separately Reimbursed.
RP-033 Anesthesia Services
Direction for physical status modifiers will be removed.
- wny
- neny
RP-037 Emergency Evaluation and Management Coding Guidelines
This policy will be 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 has been 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 will be added. Codes 92921, 92925, 92929, 92934, and 92938 will be removed.
RP-047 Venipuncture and Lab Services
Medicare Advantage direction will be changed.
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