Medicare AdvantageBilling CodesHigh impact
New and Updated Reimbursement Policies – September 2026
Highmark·PA, DE, WV · Physical Therapy, Occupational Therapy, Chiropractic +4 more·Provider Bulletin
We identified it
Sep 29, 2026
Summary
Highmark issued multiple reimbursement policy updates effective September through November 2026, including: consolidation of radiography/IDTF policies into RP-008, removal of codes 98000-98015 from bundled services in select states, updates to telemedicine alignment with CMS/AMA guidance, new observation care policy (RP-085), and upcoming changes to maternity care, therapy code bundling, and incident-to modifier requirements. Billing teams must track multiple effective dates and update systems accordingly to avoid claim denials.
Action Required
IMMEDIATE (Sept 28, 2026 - Already Effective): 1) Billing team must verify that codes 98000-98015 are now separately reimbursed in Delaware (DE), Pennsylvania (WPA/NEPA), and West Virginia (WV) - remove any bundling rules for these states in billing software. 2) Update RP-008 references in system documentation; archive RP-026 and RP-048 from active policy lists to prevent provider confusion. 3) For all regions: Add codes 77387, 77417, 77439 to non-separately reimbursed lists (RP-041) for Commercial and Medicare Advantage plans. 4) Review and implement telemedicine/telehealth policy updates per RP-046 (Sept 1 effective). NEW OBSERVATION CARE (Sept 28, 2026 - Effective Immediately): 5) Implement RP-085 - update billing logic to separately reimburse observation services ≤8 hours when billed separate from ED. Configure system for post-pay edits. UPCOMING - By Oct 1, 2026: 6) Update maternity billing for RP-023 changes; merge RP-056 direction; prepare for births on/after Jan 1, 2027 coding. UPCOMING - By Oct 26, 2026: 7) Providers in Chiropractic, Physical Therapy, Occupational Therapy, Physiatry must STOP separately billing code 97124 (Commercial and MA plans). Add code 97124 to RP-051 bundling rules; update encounter forms to alert providers. UPCOMING - By Nov 1, 2026: 8) Modify billing system to REQUIRE modifier SA when reporting incident-to services per RP-010. Update provider alerts and claim submission rules. Claims submitted without SA modifier will be subject to denial.