New and Updated Reimbursement Policies – October 2026
Published Date: Mon, Oct 26, 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
Oct. 1, 2026
RP-023 Maternity Care and Delivery Services
Effective Oct. 1, 2026, to align with new American Medical Association (AMA) coding and billing guidelines for maternity care services, Highmark made updates to RP-023 that include:
- Addition of direction for births expected on or after Jan. 1, 2027
- Addition of direction for births expected prior to Jan. 1, 2027
- Merging of direction from RP-056 Delivery Payment Equivalency (see below)
The policy name for RP-023 was also changed from “Newborn Care, Obstetrical Delivery, Antepartum and Postpartum Care, and Associated Services” to “Maternity Care and Delivery Services.”
For more information on changes Highmark is making in response to the new AMA guidelines, CLICK HERE.
RP-056 Delivery Payment Equivalency
RP-056 was archived, effective Oct. 1, 2026, with policy direction moved to RP-023 Maternity Care and Delivery Services (see above).
Oct. 26, 2026
RP-003 Convenience Kits, Drug and Biological Wastage
The coding section was updated. No changes in direction were made.
RP-051 Multiple Procedure Payment Reduction for Therapy Services
Effective Oct. 26, 2026, Highmark no longer allows 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 was added to RP-051, applicable to Commercial and Medicare Advantage for all regions. For more information, CLICK HERE.
RP-063 Consultation Services
This policy underwent an administrative review. No changes in direction were made.
Upcoming
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.
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Jan. 1, 2027
RP-068 Mid-Level Practitioners and Advanced Practice Providers
The certified registered nurse anesthetist (CRNA) specialty will no longer be applicable to this policy for Delaware Commercial.
Jan. 25, 2027
RP-011 Procedure Codes Not Applicable to Commercial Products
Codes G0556, G0557, and G0558 will be added.
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