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Oncology Management Pathways Program Fee Schedule

The Highmark Oncology Management Pathways Program builds on evidence-based medical oncology drug treatment protocols as a means of providing the highest quality patient care while simultaneously managing spiraling health care costs.

In order to encourage adoption of and compliance with the protocols, Highmark has developed a two-tiered reimbursement structure, with an Enhanced Program Fee Schedule for practices participating in the Oncology Management Pathways Program. A practice qualifies for the enhanced fee schedule by adhering to the program’s oncology treatment protocols for a minimum of 80 percent of cases involving newly diagnosed Commercial patients.

This page offers complete details regarding the base, enhanced, and Medicare Advantage fee schedules. Below you will find a downloadable file with the Highmark Oncology Management Pathways Program Fee Schedules. The file contains the following information in this order: Drug Category, Procedure Code, Code Description, Base Fee, Enhanced Fee, and Medicare Advantage Fee.

Highmark considers the Highmark Oncology Management Pathways Program Fee Schedule to be proprietary information. Highmark provides the Oncology Management Pathways Program Fee Schedule as a convenience and benefit to you and on the condition that you do 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 on the Oncology Management Pathways Program Fee Schedule are not a guarantee of 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.

When the Oncology Management Pathways Program Network Fee Schedule is updated, the files available on this site will also be updated. Please note that Highmark reserves the right to make changes to the Oncology Management Pathways Program Fee Schedule at their sole discretion.

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Last updated on 6/29/2022 4:11:25 PM

 

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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.