New and Updated Reimbursement Policies – November 2025
Mon, Nov 24, 2025
Highmark regularly issues new or updated reimbursement policies. Keep an eye on this newsletter and 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 upcoming updates to reimbursement policies (RPs):
Upcoming
Dec. 1, 2025
RP-029 Surgical Techniques, Procedures and Related Services
This policy will be made applicable to Medicare Advantage.
RP-033 Anesthesia Services
A section for Epidural Anesthesia Care will be added and direction for modifiers QK and QY reductions will be clarified. Codes 62273, 62281, 62282, and 01967-01969 will be added.
RP-077 Intraoperative Neurophysiological Monitoring
Direction will be added for codes 95941 and G0453. Code 95941 will no longer be separately reimbursed.
Dec. 24, 2025
RP-053 Advanced Gene and Cellular Therapies
New drugs/therapies applicable to this policy will be added.
Jan. 1, 2026
- wpa/ nepa
- cpa/ sepa
- wny
- neny
RP-068 Mid-Level Practitioners and Advanced Practice Providers
This policy will be updated for Commercial and Medicare Advantage to add direction for the pharmacist specialty, which will be reimbursed at 85% of the fee schedule allowance.
- wv
RP-068 Mid-Level Practitioners and Advanced Practice Providers
This policy will be updated for Medicare Advantage to add direction for the pharmacist specialty, which will be reimbursed at 85% of the fee schedule allowance.
- de
RP-068 Mid-Level Practitioners and Advanced Practice Providers
This policy will be updated to add direction for the pharmacist specialty, which will be reimbursed at 85% of the fee schedule allowance for Commercial and Medicare Advantage. Direction will also be added for the doula specialty, which will be reimbursed at 85% of the fee schedule allowance for Commercial.
NEW: RP-083 Spravato® (esketamine)
This new policy – applicable to Commercial and Medicare Advantage markets – will provide direction on the billing of esketamine (Spravato) services.
Jan. 5, 2026
RP-027 Hemodialysis and Peritoneal Dialysis
This policy will be made applicable to Medicare Advantage. Codes 99242-99245 and 99252-99255 will be removed. Codes 90993, 90999, 99233, 99291, 99292, 99341, 99387, 99391, 99392, 99393, 99394, 99395, 99396, 99397, S9335, and S9339 will be added.
Feb. 2, 2026
RP-037 Emergency Evaluation and Management Coding Guidelines
This policy will be made applicable to professional claims, which will be reviewed by Highmark when submitted for emergency department services, effective Feb. 2, 2026. For more information, CLICK HERE.
Feb. 23, 2026
RP-041 Services Not Separately Reimbursed
Codes 76376 and 76377 will be 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 will clarify when and how remote patient monitoring (RPM) should be used and when it will be reimbursed by the plan. It will provide guidelines on RPM usage by providers and reimbursement for RPM-specific Current Procedural Terminology (CPT) codes.
- 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.
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