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Fee Schedule Information

Below are links to the various fee schedules. 

ACA Product Fee Schedule
  • 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 Level 1 Fee Schedule
ACA Product PCP VBFSA Level 2 Fee Schedule
  • These files contain the Affordable Care Act Product PCP Fee Schedules with the PCP Value Based Fee Schedule Adjustments (VBFSA).
Highmark Healthy Kids (CHIP)
  • This file contains the PA CHIP Network Fee Schedule. The file contains the following information in this order: Procedure Code, Modifier, Fee, and Site of Service Indicator.*
KHPW Network Fee Schedule
  • This file contains the KHPW Network Fee Schedule, with the exception of procedure 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 Level 1 Fee Schedule
KHPW Network PCP VBFSA Level 2 Fee Schedule
  • These files contain the KHPW Network Fee Schedules with the PCP Value Based Fee Schedule Adjustments (VBFSA).
Oncology Management Pathways Program Fee Schedule
  • This file contains complete details regarding the base, enhanced, and Medicare Advantage fee schedules for the Oncology Management Pathways Program. 
PremierBlue Shield Network Fee Schedule
  • The file contains the following information in this order: Procedure Code, Modifier, Fee, and Site of Service Indicator.*
PremierBlue Shield Network PCP VBFSA Level 1 Fee Schedule
PremierBlue Shield Network PCP VBFSA Level 2 Fee Schedule
  • These files contain the PremierBlue Shield Network Fee Schedules with the PCP Value Based Fee Schedule Adjustments (VBFSA).
Skilled Nursing Facility Outpatient Fee Schedule
  • Highmark's annual updates to the Skilled Nursing Facility Outpatient Fee Schedule for Medicare Advantage members.

HIGHMARK COMMERCIAL STANDARD PROFESSIONAL FEE SCHEDULE & PRICING METHODOLOGY EFFECTIVE 10/1/2023

*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 9/5/2023 12:49:02 PM

 

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, reimbursement policy, 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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Highmark Blue Cross Blue Shield serves the 29 counties of western Pennsylvania and 13 counties of northeastern Pennsylvania. Highmark Blue Shield serves the 21 counties of central Pennsylvania and also provides services in conjunction with a separate health plan in southeastern Pennsylvania. Highmark Blue Cross Blue Shield West Virginia serves the state of West Virginia plus Washington County. Highmark Blue Cross Blue Shield Delaware serves the state of Delaware. Highmark Western and Northeastern New York Inc., serves eight counties in Western New York under the trade name Highmark Blue Cross Blue Shield of Western New York and serves 13 counties in Northeastern New York under the trade name Highmark Blue Shield of Northeastern New York. Each of these companies is an independent licensee of the Blue Cross Blue Shield Association. Blue Cross, Blue Shield and the Blue Cross and Blue Shield symbols are registered marks of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield companies. All references to “Highmark” in this document are references to the Highmark company that is providing the member’s health benefits or health benefit administration.