Fee Schedule Information

Below are links to the various fee schedules. 

  • KHPW Network Fee Schedule
    This file contains the KHPW Network Fee Schedule, with the exception of procedures codes pertaining to behavioral health services. The file contains the following information in this order: Procedure Code, Modifier, Fee and Site of Service Indicator*
  • KHPW Network PCP VBFSA Fee Schedule
    This file contains the KHPW Network Fee Schedule with the PCP Value Based Fee Schedule Adjustments (VBFSA). This initiative was communicated to the market in early 2020 through field team representatives and official online announcements and materials. 
  • PremierBlue Shield Network PCP VBFSA Fee Schedule
    This file contains the PremierBlue Shield Network Fee Schedule with the PCP Value Based Fee Schedule Adjustments (VBFSA). This initiative was communicated to the market in early 2020 through field team representatives and official online announcements and materials. 
  • ACA Product Fees Listing
    The file contains the following information in this order: Specialty (or blank if for all), Procedure, Modifier (or blank if for all), Second Modifier (or blank if for all), Allowance, Place of Service (OFFICE or blank if for all).
  • ACA Product PCP VBFSA Fees Listing
    This file contains the Affordable Care Act Product PCP Fees Listing with the PCP Value Based Fee Schedule Adjustments (VBFSA). This initiative was communicated to the market in early 2020 through field team representatives and official online announcements and materials. 

* Site of Service (SOS) Indicator should be interpreted in this way:

  • A single procedure code/modifier combination without an SOS indicator (blank) represents a fee without SOS variation.
  • A single procedure code/modifier combination with an SOS indicator of "OFFICE" represents the fee for office place of service only.
  • Procedure code/modifier combinations listed twice have a blank indicator to represent the fee for inpatient hospital and outpatient hospital place of service, and an "OFFICE" to represent the fee for office place of service.
Last updated on 10/14/2021

 

The fee schedules above are considered to be proprietary information and are being provided as a convenience and benefit to you and on the condition that you not disclose this information to anyone [other than internal personnel and your billing agents to the extent necessary for them to provide services to you and provided they have agreed to keep the information confidential.]

Fees set forth above are not a guarantee of a specific payment or of any payment and no implication should be made, based upon the existence of a fee for a specific procedure code, that payment will be made for such procedure code. Network rules, member benefits and medical policy will continue to be applied to all claims or encounters submitted.

As fee schedules are updated, the files contained on this page will also be changed. Please note that Highmark reserves the right to make changes to fee schedules at their sole discretion. 

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