Compliance, Regulatory & Policies

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

Reimbursement Policy: PO-RE-130 Discarded Drugs and Biologicals Billing Guidelines

This policy establishes guidelines for the proper billing and reimbursement of drugs and biologicals supplied in single-dose containers, specifically addressing situations involving wastage and discarding of such drugs.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-105 Removal of Impacted Cerumen

The removal of impacted cerumen (earwax) refers to the extraction of hardened or accumulated earwax from the external auditory canal using mechanical techniques, such as irrigation, lavage, or debridement.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-153 Hospital Outpatient Clinic Visit – CPT/HCPCS Code G0463

This policy outlines the billing, coding, and reimbursement guidelines for hospital clinic visits billed under HCPCS code G0463.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-175 Childhood Vaccine Counseling

Healthfirst reimburses qualified providers for childhood vaccine counseling services provided to Healthfirst Medicaid and Child Health Plus members under 21 years of age in accordance with New York State Medicaid requirements.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-125 Serum Testing for Evidence of Mild Traumatic Brain Injury

Traumatic brain injury (TBI) is characterized by pathologic injuries to the brain resulting from external forces or trauma.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-080 Colorectal Cancer Screening

Colorectal cancer (CRC) is the term used to describe the development of cancer in the colon or the rectum.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-079 Coronavirus Testing in the Outpatient Setting

Human coronaviruses, first characterized in the 1960s, are named based on the spiked proteins located on their surface. As of 2020, seven coronaviruses are known to infect humans.

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Reimbursement Policy

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-068 Prenatal Screening (Nongenetic)

Prenatal screening encompasses any testing done to determine the health status of the pregnant individual and/or fetus.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-063 General Inflammation Testing

Inflammatory response can occur due to tissue injury and/or various disorders, including arthritis, lupus, and infection.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-056 Gamma-glutamyl Transferase Testing in Adults

Gamma-glutamyl transferase (GGT), also known as gamma-glutamyl transpeptidase (GGTP),1,2 is an enzyme that has a half-life of between fourteen and twenty-six days and is present in the cell membrane of many different tissue types, including the heart, brain, seminal vesicles, kidneys, bile duct, spleen, and gallbladder

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-048 Testing for Alpha-1 Antitrypsin

Alpha 1-antitrypsin deficiency (AATD) is a genetic disease that causes deficient or defective production of the alpha-1 antitrypsin (AAT) protease inhibitor that can affect the lungs, liver, and rarely skin.

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Reimbursement Policy

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Reimbursement Policy: PO-RE-130 Discarded Drugs and Biologicals Billing Guidelines

Reimbursement Policy: PO-RE-105 Removal of Impacted Cerumen

Reimbursement Policy: PO-RE-153 Hospital Outpatient Clinic Visit – CPT/HCPCS Code G0463

Reimbursement Policy: PO-RE-175 Childhood Vaccine Counseling

Reimbursement Policy: PO-RE-125 Serum Testing for Evidence of Mild Traumatic Brain Injury

Reimbursement Policy: PO-RE-080 Colorectal Cancer Screening

Reimbursement Policy: PO-RE-079 Coronavirus Testing in the Outpatient Setting

Reimbursement Policy: PO-RE-075 Laboratory Procedures

Reimbursement Policy: PO-RE-068 Prenatal Screening (Nongenetic)

Reimbursement Policy: PO-RE-063 General Inflammation Testing

Reimbursement Policy: PO-RE-056 Gamma-glutamyl Transferase Testing in Adults

Reimbursement Policy: PO-RE-048 Testing for Alpha-1 Antitrypsin

Resource Type

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Year

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Reimbursement Policy: PO-RE-130 Discarded Drugs and Biologicals Billing Guidelines

Reimbursement Policy: PO-RE-105 Removal of Impacted Cerumen

Reimbursement Policy: PO-RE-153 Hospital Outpatient Clinic Visit – CPT/HCPCS Code G0463

Reimbursement Policy: PO-RE-175 Childhood Vaccine Counseling

Reimbursement Policy: PO-RE-125 Serum Testing for Evidence of Mild Traumatic Brain Injury

Reimbursement Policy: PO-RE-080 Colorectal Cancer Screening

Reimbursement Policy: PO-RE-079 Coronavirus Testing in the Outpatient Setting

Reimbursement Policy: PO-RE-075 Laboratory Procedures

Reimbursement Policy: PO-RE-068 Prenatal Screening (Nongenetic)

Reimbursement Policy: PO-RE-063 General Inflammation Testing

Reimbursement Policy: PO-RE-056 Gamma-glutamyl Transferase Testing in Adults

Reimbursement Policy: PO-RE-048 Testing for Alpha-1 Antitrypsin

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