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Highmark Wholecare Policy Updates

Published Date: 2024-12-17

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 August 1, 2025

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

Medicaid Policies:

MP-032-MD-PA Skin Replacement Therapy for Chronic Non-healing Wounds in the Outpatient Setting - No changes to clinical criteria. Added skin product “Axolotl” under “Not Medically Necessary” section. Added procedure codes to the “Noncovered Procedure Codes” section.
MP-069-MD-PA Home Oxygen Therapy (HOT) - Reformatted “Procedure” section and clinical guidelines. Added, changed, and removed procedure codes. All diagnosis codes have been removed.
MP-057-MD-PA Cardiac Rehabilitation, Phase II Outpatient - Updated “Procedure” section formatting. No changes to clinical criteria. Updated “Summary of Literature” and “Reference Sources” sections.
MP-063-MD-PA Genetic Testing for Warfarin and Clopidogrel Therapy - No changes to clinical criteria. Updated “Procedures” section with Program Exception statement. Updated “Summary of Literature” and “Reference Sources” sections.
MP-103-MD-PA Minimally Invasive Lumbar Decompression (MILD) - No change to “Experimental/Investigational” status. Updated “Summary of Literature” and “Reference Sources” sections.
MP-107-MD-PA Treatment of the Prostate - No changes to clinical criteria. Updated “Summary of Literature” and “Reference Sources” sections.
MP-072-MD-PA Ambulance Services – Ground - No changes to criteria. Updated “Reference Sources” section.

Medicare Policies:

MP-075-MC-PA Ambulance Services (Air) - No changes to criteria. Updated “Reference Sources” section.
MP-036-MC-PA Chromosomal Microarray Analysis: Comparative Genomic Hybridization (CGH) and Single Nucleotide Polymorphism (SNP) - No changes to clinical criteria. Updated “Reference Sources” section.
MP-080-MC-PA Cosmetic and Reconstructive Surgery (L35090) - No changes to clinical criteria. Updated “Reference Sources” section and CMS hyperlinks.