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Reimbursement Policy

Archived Policies

Highmark's reimbursement policies address claims reimbursement logic as opposed to clinical information, which is addressed on medical policy. Each reimbursement policy includes information pertaining to all Highmark markets as indicated in the header, with state specific variations indicated within the policy bulletin.

History versions of reimbursement policies are stored within the PDF files. Click the "View History" link on the first page of the policy to view previous versions.

Highmark will outline recent changes made to reimbursement policies in each edition of our Provider News newsletter. You can view the newsletter here or sign up to receive it via email here.

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Disclaimer
Reimbursement policies are intended to reflect Highmark's coding & reimbursement guidelines. Coverage for services may vary for individual members, based on the terms of the benefit contract.
Highmark retains the right to review and update the reimbursement policy guidelines at its sole discretion. These guidelines are the proprietary information of Highmark. Any sale, copying or dissemination of the reimbursement policies is prohibited; however, limited copying of reimbursement policies is permitted for individual use.
Acknowledgement
The five-digit numeric procedure codes and two-digit numeric modifiers that appear on the reimbursement policies on this WEB site were obtained from the Physician's Current Procedural Terminology Manual, © American Medical Association. Reimbursement policies on this WEB site also contain five-digit alphanumeric procedure codes and two-digit alphanumeric modifiers created by the Centers for Medicare and Medicaid Services.

Current Dental Terminology. © American Dental Association. All rights reserved.
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Legal Information

The following entities, which serve the noted regions, are independent licensees of the Blue Cross Blue Shield Association: Western and Northeastern PA: Highmark Inc. d/b/a Highmark Blue Cross Blue Shield, Highmark Choice Company, Highmark Health Insurance Company, Highmark Coverage Advantage Inc., Highmark Benefits Group Inc., First Priority Health, First Priority Life or Highmark Senior Health Company. Central and Southeastern PA: Highmark Inc. d/b/a Highmark Blue Shield, Highmark Benefits Group Inc., Highmark Health Insurance Company, Highmark Choice Company or Highmark Senior Health Company. Delaware: Highmark BCBSD Inc. d/b/a Highmark Blue Cross Blue Shield. West Virginia: Highmark West Virginia Inc. d/b/a Highmark Blue Cross Blue Shield, Highmark Health Insurance Company or Highmark Senior Solutions Company. Western NY: Highmark Western and Northeastern New York Inc. d/b/a Highmark Blue Cross Blue Shield. Northeastern NY: Highmark Western and Northeastern New York Inc. d/b/a Highmark Blue Shield.

All references to “Highmark” in this document are references to the Highmark company that is providing the member’s health benefits or health benefit administration and/or to one or more of its affiliated Blue companies.