Update to the Standard Professional Fee Schedule for Commercial

Laboratory codes to be adjusted.

Effective Jan. 1, 2026, Highmark will make an update to the standard professional fee and pricing methodology¹, which applies to the Highmark service areas in Delaware, Pennsylvania, and West Virginia, for its Commercial line of business.

The codes for Independent Laboratory and Physician Office Laboratory services will receive an upward adjustment on Jan. 1, 2026, and are applicable to the following fee schedules:

• Highmark Delaware PPO
• Highmark West Virginia PPO
• Keystone Health Plan West (KHPW) Network (Western and Northeastern Pennsylvania regions)
• PremierBlue Shield Network (Pennsylvania)

Download and Review Highmark’s Fee Schedules

Our standard professional fee schedules are accessible within Availity Essentials®. Once you log into Availity, select Claims & Payments from the task bar and then Fee Schedule Listing from the right side. You can also access fee schedules by going to Highmark’s Payer Spaces in Availity, and then select Provider Resource Center (PRC) under Applications. Once you arrive here at the PRC, select Claims & Authorizations > Reimbursement Programs > Fee Schedule Information.

¹Any changes to the commercial standard professional fee schedule and pricing methodology will comply with 18 Del. Code §§ 3342B and 3556A.