New and Updated Reimbursement Policies – May 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

May 4, 2026

RP-011 Procedure Codes Not Applicable to Commercial Products

Codes G9886, G9887, and G9888 were added.

May 25, 2026

RP-043 Care Management

This policy was updated to streamline direction and add definitions for clarity. Codes 99497 and 99498 were also added.

RP-075 Appropriate Use Criteria for Advanced Diagnostic Imaging

This policy was archived, effective May 25, 2026.

Upcoming

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.

Aug. 24, 2026

RP-012 Rigid Immobilization

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

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.