CurrentHighmark Blue Cross Blue Shield WnyPolicy G-06111

Medical Recalls, Reimbursement Policy

Governs reimbursement for repair, replacement, and related procedures when items are subject to medical recall for Highmark BCBS WNY MMC, HARP, Child Health Plus, and Essential Plan members.

Policy Summary

PayerHighmark Blue Cross Blue Shield Wny

PolicyMedical Recalls, Reimbursement Policy

Policy CodePolicy G-06111

Change TypeNo material change

Effective DateNov 1, 2018

Next Review Date

Key ActionIn applicable circumstances, providers should bill the appropriate condition code, value code, modifier, and/or diagnosis code to identify a medically recalled item.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

5applicable recalled item categories

reductionpayment reduced by device credit

recoupmentrecoupment rights

biennialreview cadence

Reimbursement for Recalled Items — Coverage Rules

Reimbursement stance and rules for recalled items

Highmark BCBS stance on reimbursement related to medically recalled items and related procedures.

Reimbursement is not allowed for repair or replacement of items due to a medical recall unless provider, state, federal, or CMS contracts and/or requirements indicate otherwise.

Applicable item categories: durable medical equipment; supplies; prosthetics; orthotics; drugs/vaccines.

Medically necessary procedures to remove and replace recalled or replaced devices are allowed for reimbursement.

If an inpatient or outpatient facility receives a partial or full credit for a replaced device, payment will be reduced by the amount of the device credit.

Highmark BCBS may recoup or recover fees from the manufacturer and/or distributor when it has reimbursed providers for repair or replacement due to a medical recall.

Policy Summary

PayerHighmark Blue Cross Blue Shield Wny

PolicyMedical Recalls, Reimbursement Policy

Policy CodePolicy G-06111

Change TypeNo material change

Effective DateNov 1, 2018

Next Review Date

Key ActionIn applicable circumstances, providers should bill the appropriate condition code, value code, modifier, and/or diagnosis code to identify a medically recalled item.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Policy Definitions

General Reimbursement Policy Definitions

TermGeneral Reimbursement Policy Definitions

ScopeDefinitions apply to reimbursement policies referenced in this document governing repair, replacement, and related procedures for medically recalled items.

ApplicabilityUsed for Highmark BCBS WNY MMC, HARP, Child Health Plus, and Essential Plan members unless superseded by contract or regulatory requirements.

UsageDefinitions should be referenced when interpreting coverage, coding, and provider billing requirements related to recalls.

Document referenceSee the Definitions section of policy G-06111 for the complete list of general reimbursement terms used throughout this policy.

OpenPayer

Medical Recalls, Reimbursement Policy

Reimbursement for Recalled Items — Coverage Rules

Coding Requirements

Billing and Provider Instructions

Policy Definitions