Update to Highmark’s Medicare Advantage Professional Physician Office Laboratory Fee Schedule

Effective Jan. 1, 2026, Highmark is updating our standard Medicare Advantage (MA) professional physician office laboratory fee schedule, which applies to the following Highmark service areas — Delaware, New York, Pennsylvania, and West Virginia.

This update is part of Highmark’s continued effort to align with industry standard values, including the Clinical Laboratory Fee Schedule created by the Centers for Medicare and Medicaid Services (CMS).

Background

Adjustments to the MA standard professional physician office laboratory fee schedule and pricing methodology enables Highmark to:

• Make changes that reflect current factors and trends in the marketplace.
• Continue to bring our fee schedules in closer alignment with Highmark’s value-based reimbursement strategies through uniform standard fees based on a percentage of CMS pricing.

How to Access Updated Laboratory Fees

You can review updated fees via the single-code lookup function within Availity Essentials^® beginning Dec. 1, 2025.

Log into Availity, select Claims & Payments from the task bar, and then click Fee Schedule Listing. Once there, input your organization's information, select your Highmark plan, and complete the remaining required fields. Next add the procedure code, including any required modifier. Click submit and you will receive the fee for this specific procedure.