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Published Date: 2025-12-10

Policy Updates

Highmark Wholecare regularly reviews and updates our policies and procedures. To help you know when policies have been amended, an advanced notification will be provided via our newsletter and posted on our website sixty (60) days prior to the effective date. You can find the updated policies at the following links:

Medicaid Provider Updates

Medicare Provider Updates

Policy Updates Effective March 1, 2026

As a reminder, we have updated or reviewed the following Medical Policies, with changes effective March 1^st. These updates will be posted on the Highmark Wholecare provider website on January 1, 2026.

Medicaid Policies:

MP-144-MD-PA Observation and Inpatient Admissions– New Policy
MP-096-MD-PA Scanning Computerized Ophthalmic Diagnostic Imaging - Added procedure code. Updated ‘Summary of Literature’ and ‘Reference Sources’ sections.
MP-110-MD-PA Speech Generating Devices - Coding Revision: Added diagnosis code, along with coding directions.
MP-075-MD-PA Myoelectric Upper Extremity Orthoses - Policy changed from 'experimental/investigational' stance to 'covered when medically necessary'. Added medical necessity coverage criteria. Added covered and noncovered HCPCS codes
MP-005-MD-PA Gene Expression Testing for Cancer Treatment (Breast, Colon, Prostate) - No changes to clinical criteria. Updated ‘Summary of Literature’ and ‘Reference Sources’ sections.
MP-061-MD-PA Molecular Tumor Markers for Non-Small Cell Lung Cancer (NSCLC) - No changes to clinical criteria. Updated ‘Summary of Literature’ and ‘Reference Sources’ sections.
MP-133-MD-PA Treatment of Varicose Veins/Venous Insufficiency - Policy Retired as InterQual® criteria exists for procedure codes listed in the ‘Coding Requirements’ section.
MP-085-MD-PA Artificial Pancreas - Policy Retired as InterQual® criteria currently exists for all procedure codes in ‘Coding Requirements’ section.

Medicare Policies:

MP-105-MC-PA Post-Acute Care – New Policy
MP-104-MC-PA and Inpatient Admissions – New Policy
MP-039-MC-PA Hyperbaric Oxygen Therapy (HBOT) (NCD 20.29) - Policy to be Retired. InterQual® criteria exists for all codes in ‘Coding Requirements’ section.
MP-103-MC-PA Treatment of Chronic Venous Insufficiency of the Lower Extremities (L34924) - Policy to be Retired. InterQual® criteria exists for all procedure codes listed in ‘Coding Requirements’ section.