Highmark Pennsylvania policy updates
Track new and updated Highmark Pennsylvania policies impacting reimbursement and clinical operations.
| Policy | Payer | Type | Specialty | Change | Effective |
|---|---|---|---|---|---|
| Care Management | Highmark Pennsylvania | Reimbursement | — | Modified | May 25, 2026 |
| Highmark List of Procedure Codes Requiring NDC | Highmark Pennsylvania | Reimbursement | — | Modified | Jul 1, 2024 |
| First Priority Health Billable PCP Services | Highmark Pennsylvania | Reimbursement | — | Modified | Jan 8, 2024 |
| Sipuleucel‑T (Provenge) for Metastatic Castrate‑Resistant Prostate Cancer | Highmark Pennsylvania | Clinical | Hematology/Oncology | Modified | Sep 26, 2016 |
| Electromyography (EMG) | Highmark Pennsylvania | Clinical | Neurology/Neurosurgery | Modified | Sep 26, 2016 |
| Experimental/Investigational Services | Highmark Pennsylvania | Clinical | Other | Modified | Mar 21, 2016 |
| Magnetic Resonance Imaging (MRI) of the Breast | Highmark Pennsylvania | Clinical | Radiology/Diagnostic Imaging | Modified | Mar 7, 2016 |
| Medicare Benefit Policy Manual reference (Chapter 15, §30) | Highmark Pennsylvania | Administrative | — | Modified | Aug 26, 2011 |
| Medication prior authorization form for weight-loss drugs (Qsymia) | Highmark Pennsylvania | Clinical | Bariatric & Obesity Management | Modified | — |
| Congestive Heart Failure (CHF) Management Program (Vida Health) | Highmark Pennsylvania | Clinical | Cardiology | Modified | — |
OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.
OpenPayer by Trek Health — Policy intelligence for billing and revenue cycle teams.
Coverage data is sourced from publicly available payer medical policy documents and updated as payers publish revisions. Read more about where our data comes from. Always consult the primary payer source for clinical decision-making.