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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2025
Reimbursement Policy: PO-RE-143 Somatosensory Evoked Potentials/Responses (SEPs/SERs)

This reimbursement policy outlines the guidelines for the coverage and reimbursement of Somatosensory Evoked Potentials (SEPs) and Somatosensory Evoked Responses (SERs) as per the Centers for Medicare & Medicaid Services (CMS) Local Coverage Determination (LCD) L34975 and Local Coverage Article A56773 for Jurisdictions H and L.

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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2025
Reimbursement Policy: PO-RE-136 Brainstem Auditory Evoked Potentials and Responses (BAEPs/BAERs)

This policy outlines the reimbursement guidelines for Brainstem Auditory Evoked Potentials (BAEPs) and Brainstem Auditory Evoked Responses (BAERs) testing, in accordance with Local Coverage Determination (LCD) L34975 and Local Coverage Article A56773, Jurisdiction H and L.

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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2025
Reimbursement Policy: PO-RE-129 Medicare Physician Fee Schedule Status Indicators

The purpose of this reimbursement policy is to define the payment criteria for covered services as designated by the Centers for Medicare and Medicaid Services (CMS), particularly those classified as "always bundled" when billed alongside another physician's procedure or service.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2025
Reimbursement Policy: PO-RE-142 Home Sleep Test (HST)

A Home Sleep Test (HST) is designed to help diagnose sleep disordered breathing conditions in a home-setting.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2024
Reimbursement Policy: PO-RE-113 Doula Services

Effective January 1, 2025, Healthfirst will provide coverage of Doula Services provided in accordance with 42 CFR section 440.130(c). This policy outlines Healthfirst guidelines for the reimbursement of Doula Services.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2025
Reimbursement Policy: PO-RE-074 Remote Patient Monitoring and Remote Therapeutic Monitoring

The purpose of this policy is to outline the reimbursement guidelines for Remote Patient Monitoring (RPM) services and Remote Therapeutic Monitoring (RTM) services offered by Healthfirst.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2025
Reimbursement Policy: PO-RE-078 Telemedicine

This policy outlines the guidelines for telemedicine and telehealth services eligible for reimbursement by Healthfirst.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2025
Reimbursement Policy: PO-RE-106 e-Consult Visits

This document describes the eConsult visit policy Healthfirst Utilization Management follows when reimbursing for services provided by contracted providers.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2025
Reimbursement Policy: PO-RE-095 Anesthesia Services

Healthfirst Anesthesia policy is developed in part using the Centers for Medicare and Medicaid Services (CMS) National Correct Coding Initiative (NCCI) Policy Manual, CMS NCCI edits and the CMS Regional Physician Fee Schedule, American Society of Anesthesiologists guidelines, and its own medical policies regarding the coding of claims.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2025
Reimbursement Policy: PO-RE-127 Canalith Repositioning Procedure

Healthfirst adheres to the Centers for Medicare & Medicaid Services (CMS) guidelines for Canalith Repositioning Procedures. This policy outlines the reimbursement criteria and procedure for the CPT code 95992, which is designated for the therapeutic management of benign paroxysmal positional vertigo (BPPV).

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2025
Reimbursement Policy: PO-RE-131 Psychological and Neuropsychological Testing

Effective May 1, 2025, Healthfirst will implement a new reimbursement policy for Psychological-Neuropsychological testing. This policy is aligned with Local Coverage Determination L34520 and Local Coverage Article A57780 R-10-01-2024 (Jurisdiction N).

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2025
Reimbursement Policy: PO-RE-001 Vitamin D Testing

Vitamin D is a precursor to steroid hormones and plays a key role in calcium absorption and mineral metabolism.

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Reimbursement Policy
  
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