New and Updated Reimbursement Policies – September 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

Sept. 1, 2026

RP-046 Telemedicine and Telehealth Services

Effective Sept. 1, 2026, Highmark updated 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.

Sept. 7, 2026

RP-040 Facility Routine Supplies and Services

This policy underwent an administrative review. No changes in direction were made.

Sept. 28, 2026

RP-008 Mobile or Independent Diagnostic Services and X-rays

This policy was updated to merge direction from RP-026 Portable Radiography and ECG Services – Modifiers UN, UP, UQ, UR, US (see below) and RP-048 Independent Diagnostic Testing Facility (IDTF) (see below). The policy name for RP-008 was also changed from “X-rays Using Film, Computed Radiography, and Computed Tomography: Modifiers FX, FY, CT” to “Mobile or Independent Diagnostic Services and X-rays.”

RP-026 Portable Radiography and ECG Services – Modifiers UN, UP, UQ, UR, US

RP-026 was archived, effective Sept. 28, 2026, with policy direction moved to RP-008 Mobile or Independent Diagnostic Services and X-rays (see above).

RP-041 Services Not Separately Reimbursed

Codes 77387, 77417, and 77439 were added for Commercial and Medicare Advantage. In addition, a list of Status B codes – which has already been applicable for Medicare Advantage – was added for clarity.

RP-048 Independent Diagnostic Testing Facility (IDTF)

RP-048 was archived, effective Sept. 28, 2026, with policy direction moved to RP-008 Mobile or Independent Diagnostic Services and X-rays (see above).

RP-055 Nominal Charges

This policy underwent an administrative review. No changes in direction were made.

RP-081 Critical Care with Home Discharge

This policy underwent an administrative review. No changes in direction were made.

NEW: RP-085 Observation Care

Aligning with the Centers for Medicare and Medicaid Services (CMS), this new policy provides reimbursement direction for observation services when performed for eight hours or less and separately payable from emergency room billing. This policy direction is enforced on a post-pay basis.

Upcoming

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 will make 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 will also change 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 will be archived, effective Oct. 1, 2026, with policy direction being moved to RP-023 Maternity Care and Delivery Services (see above).

Oct. 26, 2026

RP-051 Multiple Procedure Payment Reduction for Therapy Services

Effective Oct. 26, 2026, Highmark will no longer allow 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 will be 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 will be made.

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.