New and Updated Reimbursement Policies – September 2025
Mon, Sep 29, 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):
- wny
- neny
Recently Updated
Sept. 22, 2025
RP-041 Services Not Separately Reimbursed - This policy was updated to indicate that codes 98000-98015 are now separately reimbursed in New York.
RP-046 Telemedicine and Telehealth Services - This policy was updated to indicate that codes 98000-98015 are now separately reimbursed in New York.
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.
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.
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