Medical Policies
Navigate coverage easily with integrated procedure and diagnosis codes.
Highmark Medical Policies
Highmark Policy Search
Find comprehensive medical policy guidelines for all of Highmark’s medical-surgical products, including managed care.
Medicare Advantage Policy Search
Highmark adheres to the Centers for Medicare and Medicaid Services (CMS) coverage determinations for Medicare Advantage (MA) membership. Search the Medicare Coverage Database (MCD) for more info.
Preferred Products for Medicare Advantage
Preferred products help lower drug prices while maintaining access to covered services and drugs.
MCG Clinical Criteria
Highmark has incorporated MCG Health evidence-based clinical guidelines into our criteria of clinical decision support.
Medical Policy Frequently Asked Questions (FAQ)
Mission Statement
The Medical Policy Department's mission is to develop and maintain evidence-based coverage guidelines.
Additional Help
Provider Service Center
If you are still unable to find a solution, call us: 8 a.m. to 5 p.m. EST, Monday through Friday.
Clinical Services
Unable to find a solution? Call us: 8:30 a.m. to 7 p.m. Monday to Friday, 8:30 a.m. to 4:30 p.m. Saturday & Sunday.
