Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026

Reimbursement Policy: PO-RE-133 Therapeutic Drug Monitoring for 5-Fluorouracil

Chemotherapeutic agents are incredibly potent drugs, often carrying cytotoxic side effects.

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Reimbursement Policy

Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026

Reimbursement Policy: PO-RE-132 Obstetric Billing Guidelines

This policy describes the reimbursement of global obstetrical (OB) codes and the itemization of maternity care services.

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Reimbursement Policy

Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026

Reimbursement Policy: PO-RE-104 Principal and Chronic Care Management

This policy outlines Healthfirst reimbursement guidelines for Principal and Chronic Care Management (PCM and CCM) services in an outpatient setting

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Reimbursement Policy

Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026

Reimbursement Policy: PO-RE-082 Testing of Homocysteine Metabolism-Related Conditions

Homocystinuria is a metabolic condition in which the body is unable to properly process certain amino acids, resulting in an abnormal accumulation of homocysteine and its metabolites in the blood and urine.

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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026

Reimbursement Policy: PO-RE-075 Laboratory Procedures

To be considered for reimbursement, all outpatient laboratory claims should be submitted in accordance with: -AMA CPT and HCPCS coding and ICD-10 diagnosis coding guidelines -Other laboratory and pathology coding guidelines -All applicable regulatory guidelines

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Reimbursement Policy

Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026

Reimbursement Policy: PO-RE-065 Diagnosis of Idiopathic Environmental Intolerance

Idiopathic environmental intolerance (IEI), formerly called multiple chemical sensitivity (MCS), is a subjective condition characterized by recurrent, nonspecific symptoms attributed to low levels of chemical, biologic, or physical agents in the absence of consistent objective diagnostic physical findings or laboratory tests that define an illness.

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Reimbursement Policy

Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026

Reimbursement Policy: PO-RE-046 Nerve Fiber Density Testing

Nerve fiber density testing involves analysis of skin biopsy stained with an antibody to antiprotein gene product 9.51 which avidly stains all axons.

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Reimbursement Policy

Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026

Reimbursement Policy: PO-RE-038 Immunohistochemistry

Immunohistochemistry (IHC) is a very sensitive and specific staining technique that uses anatomical, biochemical, and immunological methods to identify cells, tissues, and organisms by the interaction of target antigens with highly specific monoclonal antibodies and visualization though the use of a biochemical tag or label.

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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026

Reimbursement Policy: PO-RE-037 Urinary Tumor Markers for Bladder Cancer

Bladder cancer is defined as a malignancy that develops from the tissues of the bladder.

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Reimbursement Policy

Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026

Reimbursement Policy: PO-RE-036 Immune Cell Function Assay

Immune cell function assays involve measurement of peripheral blood lymphocyte response (intracellular ATP levels, proliferation) following stimulation to assess the degree of functionality of the cell-mediated immune response.

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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026

Reimbursement Policy: PO-RE-029 Testosterone Testing

Testosterone is a naturally occurring lipophilic androgen hormone that is produced by both males and females for various functions.

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Reimbursement Policy

Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026

Reimbursement Policy: PO-RE-006 Vitamin B12 and Methylmalonic Acid Testing

Vitamin B12, also known as cobalamin, is a water-soluble vitamin required for proper red blood cell formation, key metabolic processes, neurological function, and DNA regulation and synthesis.

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Reimbursement Policy

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Reimbursement Policy: PO-RE-133 Therapeutic Drug Monitoring for 5-Fluorouracil

Reimbursement Policy: PO-RE-132 Obstetric Billing Guidelines

Reimbursement Policy: PO-RE-104 Principal and Chronic Care Management

Reimbursement Policy: PO-RE-082 Testing of Homocysteine Metabolism-Related Conditions

Reimbursement Policy: PO-RE-075 Laboratory Procedures

Reimbursement Policy: PO-RE-065 Diagnosis of Idiopathic Environmental Intolerance

Reimbursement Policy: PO-RE-046 Nerve Fiber Density Testing

Reimbursement Policy: PO-RE-038 Immunohistochemistry

Reimbursement Policy: PO-RE-037 Urinary Tumor Markers for Bladder Cancer

Reimbursement Policy: PO-RE-036 Immune Cell Function Assay

Reimbursement Policy: PO-RE-029 Testosterone Testing

Reimbursement Policy: PO-RE-006 Vitamin B12 and Methylmalonic Acid Testing

Resource Type

Filter

Year

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Reimbursement Policy: PO-RE-133 Therapeutic Drug Monitoring for 5-Fluorouracil

Reimbursement Policy: PO-RE-132 Obstetric Billing Guidelines

Reimbursement Policy: PO-RE-104 Principal and Chronic Care Management

Reimbursement Policy: PO-RE-082 Testing of Homocysteine Metabolism-Related Conditions

Reimbursement Policy: PO-RE-075 Laboratory Procedures

Reimbursement Policy: PO-RE-065 Diagnosis of Idiopathic Environmental Intolerance

Reimbursement Policy: PO-RE-046 Nerve Fiber Density Testing

Reimbursement Policy: PO-RE-038 Immunohistochemistry

Reimbursement Policy: PO-RE-037 Urinary Tumor Markers for Bladder Cancer

Reimbursement Policy: PO-RE-036 Immune Cell Function Assay

Reimbursement Policy: PO-RE-029 Testosterone Testing

Reimbursement Policy: PO-RE-006 Vitamin B12 and Methylmalonic Acid Testing

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