CommercialReimbursementHigh impact
Update: Expanded List of Non-Specific Codes Subject to Additional Review
Highmark·DE, PA, WV, NY·Provider Bulletin
Effective date
Jul 15, 2026
We identified it
Jun 12, 2026
Summary
Highmark is expanding review of more than 100 non-specific CPT codes (not otherwise classified/specified codes) starting July 15, 2026 in DE/PA/WV and August 15, 2026 in NY. Claims with these codes will undergo additional medical necessity review and receive only 35% of billed amount if approved, unless more specific codes are available.
Action Required
By July 15, 2026 (DE/PA/WV) or August 15, 2026 (NY): Billing team must review the expanded list of non-specific codes at Highmark's website and update billing practices to use the most specific CPT codes available instead of non-specific codes. Train providers on proper code selection as claims with non-specific codes when more appropriate codes exist will be rejected. Update billing system to flag that approved non-specific codes will only reimburse at 35% of billed amount.