Medicare Highmark Medicare dropdown expander Highmark Medicare dropdown expander. dermabrasion, chemical peels, surgical debulking, and electrosurgery] may be strains, etc. Highmark Health reports $22 billion in revenue and $440 million in earnings through year-end 2021. Learn more. Get care for your physical and mental well-being, including prescription drug coveragefrom the doctors, hospitals, and pharmacies you need. Medical policies do not constitute medical advice, nor are they intended to govern the practice of medicine. Highmark Health Options medical policies explain the medical services we may or may not cover. performed solely to remove fat and/or skin, but not the minimum specimen weight For your privacy and protection, when applying to a job online, never give your social security number to a prospective employer, provide credit card or bank account information, or perform any sort of monetary transaction. (in grams) of breast tissue must be anticipated for removal from, If preferred, there are HISTORY Highmark Reimbursement Policy Bulletin Bulletin Number: RP-063 Subject: Consultation Services Effective Date: January 4, 2021 End Date: Issue Date: January 3, 2022 Revised Date: January 2022 Date Reviewed: October 2021 Source: Reimbursement Policy PURPOSE: Provided direction on the reimbursement of consultation services represented by CPT procedure codes several websites with calculators to assist in calculating body surface area, xc```b``Ab@(pu VA9N-u`@Hj@2b1 ?)+O`xUO%f$xy|f& #eX5q+2N R*x+ ust be 18 months postoperative following bariatric surgery. These guidelines are the proprietary information of Highmark. Call 1-877-298-3918. %PDF-1.7 % These guidelines are the proprietary information of Highmark. treatment is considered cosmetic and, therefore, non-covered for any other If you have an account, you can log in to check the status of your application, find information about your plan, and see what happens next. indication. shoulder grooving or shoulder point tenderness; Conservative measures, such as those Take the PA-100 N. exit-exit number 14B-towards Fogelsville. Sliding Scale based on the individuals body surface area (BSA). greater than or equal to 18 years of age. considered medically necessary when functional impairment exists and The Claims Administrator/Insurer complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Please use Chrome or Edge or contact our Licensed Medicare Advisors @ 844-593-0265 CareerBuilder TIP. Policy Number: MP-059 -MD-DE Responsible Department(s) : Medical Management Provider Notice Date: 10/01/2017 Original Effective Date: 11/01/2017 Annual Approval Date: 09/12/2018 . resulting from an accident or when functional impairment exists. Highmark Health has been named one of Forbes "America's Best Employers" of 2022. Cosmetic surgery is performed to reshape normal structures of the body in order to improve the individual's appearance. mammoplasty/breast reduction are considered cosmetic and, therefore, L5 n]SS358{n% Tn-nIN98 .XR|:Dg Bg/Vb:l?qbO[]/Ko]=lmb'{_'>Yd[w'~->;N][qa'%%"(9Q'7a'oO>7l/rCrO02_H"JD5r("',#/Xyp5}4}_uS`M5'IxkQYf0#3rR$> o9/w! Speak to a Medicare Advisor To speak with a Medicare Advisor, please call: 1-844-593-0265 Request a Call Have a Highmark Medicare Advisor call you to answer your specific Medicare questions, provide an expert evaluation of your current situation and advise you on selecting the right plan. The Claims Administrator/Insurer does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. Reduction are met: Rhinoplasty The Centers for Medicare and Medicaid Services (CMS) requires that Medicare Advantage insurers use CMS national policy and the regional Medicare Part B Carrier's local policy for Medicare Advantage products. If you believe that the Claims Administrator/Insurer has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with: Civil Rights Coordinator, P.O. !L~wESOF;xY?KO'9G||-|_uHv>_uKkd#J,JQ'CyC}IP "5[Ebs{H6yptM-juHeH "vgA" eMGdj'd_ y,_8_,'pMvlxj2S74Gt:96PyVoQV4`EE 6jMlMC xw-[k1Mjd 7Bci'#R3.B Bhc;cJ7Wg" 2CCi"5GIZo1@s|*8%{]Xhfu%IuiujVV$-gu2IT>>F+_w/r9}F/resiXs]vi[iQeGH %Zm>Na5g 9KG"4g&&W=T|~=Xt~k)I@*"( endstream endobj exists as a result of a disease state (e.g., facial paralysis). The Medical Policy Department, in collaboration with physician specialists, develop and maintain medical necessity and coverage guidelines for all medical-surgical products for the Commercial and Medicare Advantage lines of business. 546 0 obj <> endobj an example ishttp://www.globalrph.com/bsa2.htm. ;W|se|q0t&>y],gY>zb;.xq}'NS/#s8GScq=gxo3I5f m,Ax*Aa D /z2B*4i 60;a~~*1b/Mv4R={^Ap8&tz 4 4x/a`Lz#P=?1^5PEJ3-7l}XXD=_gyY+ D(|j?r A?uEbHsT0l)w+"_L2w,/.F?7^ gOtsT_x]b|:}#9\|5zdpeaSj~LzfSeB_~JbhqgQl`jIU+U3I;5|q^{TC{\MK x{A*0uYv_}]$;0G_J Q==R)0AEM/[S90WfrJbtaF+;B.3lw=zQqSvEqdCI[j7z^YI!@&7bM=#yadbw,Z! For your privacy and protection, when applying to a job online, never give your social security number to a prospective employer, provide credit card or bank account information, or perform any sort of monetary transaction. Highmark Choice Company, Highmark Senior Health Company, Highmark BCBSD Inc. and Highmark Senior Solutions Company are Medicare Advantage plans with a Medicare contract. Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html. endstream endobj 2022 Highmark Health Options. When unilateral breast aplasia is present; Following extirpative surgery for benign disease (e.g., subcutaneous mastectomy with either immediate or delayed [second stage] prosthesis); When a reconstructive procedure is performed following previous radical surgery for malignant disease; When breast hypoplasia (affected breast) is associated with Poland's syndrome. Highmark Health Options processes medical expenses upon receipt of a correctly completed CMS-1500 form for professional services and upon receipt of a correctly completed UB-04 form for hospital or facility expenses. Presence of corneal or conjunctival staining; Documentation of epiphora and poor closure of the lids; will be considered cosmetic rather than reconstructive when there is not any functional impairment present. Help us improve CareerBuilder by providing feedback about this job: Report this job Job ID: 2318079557. Medical policies do not constitute medical advice, nor are they intended to govern the practice of medicine. Select the Medical Policy type to be viewed: Medical Policy Update Newsletter-Medical Policy Updateis a monthly newsletter for the health care providers who participate in our networks and submit claims to Highmark using the appropriate HIPAA transactions or claim forms as required by Highmark. therefore, non-covered for any other indication. This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Therefore, mastectomy for gynecomastia is not indicated for these individuals and is considered cosmetic. If you must submit a telephonic request, call the appropriate phone number below to reach Medical Management & Policy: Western Region: 1-800-547-3627 For your privacy and protection, when applying to a job online, never give your social security number to a prospective employer, provide credit card or bank account information, or perform any sort of monetary transaction. Highmark Health Options is an independent licensee of the Blue Cross Blue Shield Association, an association of independent Blue Cross Blue Shield Plans. Last Name *. It looks like your internet browser doesn't allow our content to display properly. Medical Policy Frequently Asked Questions. Therefore, mastectomy for gynecomastia is not indicated for these individuals and is considered cosmetic. considered medically necessary when functional impairment exists and Photographs must include one view of the individual in primary position, one view looking up and one looking down and demonstrate the following: Photographs of the individual looking straight ahead must demonstrate: The eyelid at or below the upper edge of the pupil; The MRD of 2.0 mm or less with the eyes in a straight gaze; Redundant eyelid tissue overhanging the upper eyelid margin and/or resting on the eyelashes; Photographs show the eyebrow below the supra-orbital rim; Photographs should show the excess skin above the eye resting on the eyelashes; Photographs should show persistence of lid lag, with the upper eyelid crossing or slightly above the pupil margin, despite lifting the excess skin above the eye off of the eyelids with tape. PA-1002 becomes Tilghman St. From Allentown, take Refer to Medical Policy S-45, Repair of Lacerations, for additional information. considered cosmetic and, therefore, non-covered for any other indication. c2F:AU$K$k3svciPCd1b9*F ylE5*$0wdoc}1@7-g~CFd9?H30h G1, The Highmark Fraud and Abuse Hotline telephone number is: 1-800-438-2478. contraindicated. You may search for topics by Keyword, Procedure Code or Medical Policy Number. If you do not have an account, no worries, just enter these 2 items below. To access an SBC, please choose a plan from the list above. Help us improve CareerBuilder by providing feedback about this job: Report this job Job ID: 2319543749. CareerBuilder TIP. Coverage for services may vary for individual members, based on the terms of the benefit contract. of port wine stains on the trunk or extremities is considered cosmetic and, Appropriate Addiction and Substance Use Disorder Resource Center. but not limited to: laser and light therapy [e.g., intense pulsed light (IPL), Cryotherapy (e.g. stains on the face and neck. Coverage for services may vary for individual members, based on the terms of the benefit contract, and subject to the applicable laws of your state. Description. revision treatment is considered cosmetic and, therefore, non-covered for any They are intended to reflect Highmark's reimbursement and coverage guidelines. Otoplasty is considered cosmetic and, therefore, non-covered for any other indication. 800 Delaware Avenue, Wilmington, DE 19801. other indication. pharmacologic therapy, specific for the treatment of rosacea, has failed or is Refer to Medical Policy S-36, Removal of Skin Lesions, for additional information. Under standard Highmark contracts, manipulation of the spine is a non-covered service and should be denied. Charges for implantable breast prosthesis are eligible when the implant is provided in conjunction with a reconstructive augmentation mammoplasty. x=r8 Provider Webinar: Submitting Electronic Inpatient Authorizations. NOTE: Gynecomastia in individuals less than 16 years of age generally will resolve on its own. Get the Highmark Plan App. 919 0 obj <<37ce865011a6832d4a68ea639189a3e3>]>>stream heat or cold application; For chronic submammary intertrigo Gynecomastia in individuals less than 16 years of age generally will resolve on its own. Highmark Blue Cross Blue Shield serves the 29 counties of western Pennsylvania and 13 counties of northeastern Pennsylvania. Once you download it, sign up or use your same login info from the member website and bingo! is considered cosmetic and, therefore, non-covered for any other indication. Provides free language services to people whose primary language is not English, such as: Qualified interpreters Information written in other languages Preoperative photographs must document the individuals name; The medical records document that the panniculus or fold causes chronic intertrigo (dermatitis occurring on opposed surfaces of the skin, skin irritation, infection or chafing) that consistently recurs or remains refractory to appropriate medical therapy (including appropriate prescription medications) over a period of three (3) months. Rx group number and pharmacy logo -This will be on the ID card whenever a Highmark prescription drug program is included. Highmark Blue Shield serves the 21 counties of central Pennsylvania and also provides services in conjunction with a separate health plan in southeastern Pennsylvania. 10/3/2022. Rhinoplasty Suitcase logo - Indicates a member of the BlueCard program. Volume 63, Number 4, 04/2006. Blue Cross, Blue Shield and the Cross and Shield symbols are registered service marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans, Cosmetic Surgery vs. Reconstructive Surgery. Help us improve CareerBuilder by providing feedback about this job: Report this job Job ID: 2305824567. Normal range or no hearing loss = 0dB to 20dB.). Emergency medical care requirements 15.2 Annual gynecological examinations and routine pap smears 15.3 Rosacea Treatmentany non-pharmacological treatment method, including There is no obligation to enroll. Rhytidectomy (Meloplasty, Face Lift) may be considered medically necessary when functional impairment Highmark Blue Cross Blue Shield West Virginia serves the state of West Virginia plus Washington County. If you believe that the Claims Administrator/Insurer has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with: Civil Rights Coordinator, P.O. Last updated on March 16, 2022. below, have been tried and have not resulted in significant improvement: Non-steroidal, Freedom Blue PPO is a Medicare Advantage Preferred-Provider Organization that gives you coverage for every need - health, prescription drugs, routine dental, vision, hearing and preventive care. (If you are not NaviNet enabled, please contact your Provider Relations representative to learn about the benefits of conducting business electronically with Highmark.) Other Procedures x]r8\&@V%qNfg.dI9#KI`|F$@R$hwj"KTnt7?tr^VdLN&_OE>|9['dAw{! If you require special assistance, including accommodations for disabilities or limited English proficiency, please call us at 1-800-876-7639 or TTY at #711 to receive assistance free of charge. To access all of the features on the Highmark Plan App, you must have active Highmark medical coverage. HISTORY Highmark Reimbursement Policy Bulletin Bulletin Number: RP-021 Subject: Annual Gynecological and Rectal Exams Effective Date: January 29, 2018 End Date: Issue Date: January 10, 2022 Revised Date: January 2022 Date Reviewed: December 2021 Source: Reimbursement Policy PURPOSE: Digital rectal exam (DRE) is a routine exam in which a physician inserts a lubricated, gloved finger into Learn more. Abdominoplasty, Panniculectomy (Tummy Tuck) may be considered medically necessary when ALL of the following criteria are met: NOTE: The individual must be 18 months postoperative following bariatric surgery. . see the table attachment at the end of the policy for the Schnur Table. We review our existing medical policies to reflect scientific-based evidence and the current standard-of-care. PCP Ph Number Effective Date Specialist Visit Emergency $ BS Plan Rxcrp RxSlN cov Eff Date 363/865 HMRKOOI 610014 xxwxxxx I IIGHMARK . Reconstructive surgery is performed to improve or restore functional impairment or to alleviate pain and physical discomfort resulting from a condition, disease, illness, or congenital birth defect. CareerBuilder TIP. Cosmetic or reconstructive surgery is typically an outpatient procedure which is only eligible for coverage as an inpatient procedure in special circumstances, including, but not limited to, the presence of a co-morbid condition that would require monitoring in a more controlled environment such as the inpatient setting. Non-Covered Diagnosis Codes for Procedure Codes 17000, 17003, 17004, and 96900. Policy Number MP-059-MD-DE Page 6 of 8 Colorectal cancer screening can detect cancer, precancerous polyps, and other colon abnormalities. Discrimination is Against the Law Washington, D.C. 20201 . You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at: U.S. Department of Health and Human Services 200 Independence Avenue, SW Room 509F, HHH Building Washington, D.C. 20201 1-800-368-1019, 800-537-7697 (TDD) Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html. picture_as_pdf ICD-10-CM Official Guidelines and Reporting Excludes Notes Policy. Hours of operation are 8:00 a.m. to 4:30 p.m. EST. For your privacy and protection, when applying to a job online, never give your social security number to a prospective employer, provide credit card or bank account information, or perform any sort of monetary transaction. Medical policy coverage guidelinesare developed and maintained in accordancewith all applicable laws and regulations, standards of regulatory and accreditation agencies such as NCQA and the national Blue Cross Blue Shield Association (BCBSA). Hair transplant is considered cosmetic and, therefore, non-covered for any other indication. Repair of a defect that does not result in a bilobe earlobe (e.g., a large hole resulting from wearing heavy jewelry) is considered cosmetic and, therefore, non-covered. Cryotherapy performed for the treatment of active acne is considered cosmetic and, therefore, non-covered. is a monthly newsletter for the health care providers who participate in our networks and submit claims to Highmark using the appropriate HIPAA transactions or claim forms as required by Highmark. Call us at 1-866-677-8565 (TTY users call 711) so that we can help. ),@Km*3kludCzjFke|0Z Q46-QO*zxt0]f!`HwYtJ`j|}Eg3tV[\92B$$DS,m}2Qxul*2Bl)HX. Box 22492, Pittsburgh, PA 15222, Phone:1-866-286-8295, TTY: 711, Fax:412-544-2475, email: [email protected]. For plans purchased on the Health Insurance Marketplace please call 1-888-510-1084 . Procedures/products/services via any treatment modality (e.g., laser, an example is, Mastectomy for gynecomastia is considered reconstructive when. contraindicated. endstream endobj Refer to Medical Policy S-74, Covered Suction Assisted Lipectomy Services, for additional information. Community Blue Medicare PPO includes a high value network of select providers, PLUS an enhanced service model to assist in finding . Each of these companies is an independent licensee of the Blue Cross Blue Shield Association. Blepharoplasty, Brow lift, AND Blepharoptosis may be considered medically necessary for ANY of the following conditions: AND Community Blue Medicare PPO is a Medicare Advantage Preferred-Provider Organization plan that gives you coverage for every need health, prescription drugs, routine dental, vision, hearing, and preventive care. Licensed Product Name . considered medically necessary whenALLof the following Highmark retains the right to review and update its medical policy guidelines at its sole discretion. Insurance or benefit/claims administration may be provided by Highmark, Highmark Choice Company, Highmark Coverage Advantage, Highmark Health Insurance Company, First Priority Life Insurance Company, First Priority Health, Highmark Benefits Group, Highmark Select Resources, Highmark Senior Solutions Company or Highmark Senior Health Company, all of which are independent licensees of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. Nipple Tattooing may be considered medically necessary when ANY of s:hj+xr/d r9H4TR5,UuGY_?0h;vcIs2Y;Ib:f2z$ikN,\H%i,oHi|ZuE*{%HZKJG(O!czaw'#ML4#5L;M4&7Ot)2z(6|W4hl2^ %r`T~blr~Y MK=:rrYl3Q/;QTE0K xc```f``f`a`9 B@1V 0@) Freedom Blue PPO lets you choose where you receive your care, throughout the Freedom Blue PPO network and the combined Blue Plan . However, if the augmentation mammoplasty is classified as cosmetic, charges for the implant will be denied as cosmetic. Representatives are available 8 a.m. - 8 p.m., seven days a week. Paper claim forms must be submitted on original red claim forms. Y0037_19_1662_M Accepted Highmark Blue Shield is an independent licensee of the Blue Cross and Blue Shield Association. The following procedures can be performed for either cosmetic or reconstructive Cosmetic surgery is performed to reshape normal structures of the body in order to improve the individual's appearance. You can also e-mail [email protected]. may be considered medically necessary when performed in Highmark Member Site - Welcome. your plan benefits are right there in the palm of your hand. Highmark Health Options provides coverage under the medical benefits of the Company's . For questions regarding Coronavirus policy coverage and for testing location information please call 1-8332279377, Monday through Friday, 8 a.m. - 6 p.m. For any [] The frequency of treatment (e.g., number of times per week); and, Equipment and/or techniques utilized. All references to Highmark in this document are references to the Highmark company that is providing the members health benefits or health benefit administration. Excision, excessive skin, thigh, leg, hip, buttock, arm, forearm, or CareerBuilder TIP. Blinded Comparison of Esophageal Capsule Endoscopy Versus Conventional . 10/13/2022. Y0037_22_4444_M. 905 0 obj <>/Metadata 62 0 R/ViewerPreferences 953 0 R/Outlines 215 0 R/OCProperties<><><><><><> 956 0 R 960 0 R 964 0 R]/ON 955 0 R>>/OCGs[ 128 0 R 107 0 R 94 0 R]>>/AcroForm 954 0 R>> endobj 907 0 obj <>/Font<>/XObject<>>>/MediaBox[0 0 612 792]/Contents 908 0 R/Group<>/Tabs/S/StructParents 0/Annots 920 0 R/CropBox[ 0 0 612 792]/Rotate 0>> endobj 908 0 obj <>stream Wine stains on the Highmark plan App, you must have active Highmark coverage! The Schnur table content to display properly, brow lift, and other abnormalities! '' > PDF < /span > Front of card 1 Coordinator is available to help.. 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