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Published Date: 2025-07-22

Highmark Wholecare Policy Updates

Highmark Wholecare regularly reviews and updates our policies and procedures. To help you know when policies have been amended, we post a Provider Notice to our website one month (30 days) prior to the effective date. You can find these Provider Notices on the first of each month at the following links:

Medicaid Provider Updates

Medicare Provider Updates

Policy Updates Effective June 1, 2025

As a reminder, we have updated or reviewed the following Medical Policies, with changes effective June 1. These updates were previously posted on the Highmark Wholecare provider website May 1, 2025.

Medicaid Policies:

MP-033-MD-PA Gender Affirmation Services - Prior authorization for listed procedure codes are provided under HealthHelp.
MP-011-MD-PA BRCA1 and BRCA2 Genetic Mutation Testing - No changes to clinical criteria. Updated procedure code descriptions; removed deleted procedure codes. Updated “Summary of Literature” and “Reference Sources” sections.
MP-053-MD-PA Carpal Tunnel Surgery - No changes to clinical criteria. Updated “Summary of Literature” and “Reference Sources” sections.
MP-058-MD-PA Pulmonary Rehabilitation (PR) - No changes to clinical criteria. Updated “Summary of Literature" section.

Medicare Policies:

MP-040-MC-PA Home Oxygen Therapy (L33797) - No changes to clinical criteria. Removed retired NCD 240.2.2. Updated “Reference Sources” section.
MP-051-MC-PA Automatic External Defibrillators (AED) (L33690) - No changes to clinical criteria. Updated “Reference Sources” section.
MP-060-MC-PA Blood Glucose Testing (NCD 190.20) - No changes to clinical criteria. Updated “Reference Sources” section.

HealthHelp is a separate company that offers education and guidance from specialists in sleep, cardiology, radiation oncology, physical medicine, diagnostic imaging, and musculoskeletal and interventional pain management for Highmark Wholecare.