Compliance, Regulatory & Policies

Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2025

Reimbursement Policy: PO-RE-147 Skin Substitute Grafts and Cellular or Tissue based Products (CTPs)

This policy outlines reimbursement guidelines for the application of skin substitute graft and cellular and or tissue-based products (CTPs) used in the treatment of acute and chronic wounds, including but not limited to diabetic foot ulcers, venous leg ulcers, burns, breast reconstruction and surgical wounds.

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Reimbursement Policy

Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2025

Reimbursement Policy: PO-RE-146 Chronic Disease Self-Management Program (CDSMP) for Arthritis

This policy establishes the guidelines and requirements for the reimbursement of evidence-based Chronic Disease Self-Management Program (CDSMP) services for Arthritis provided to eligible Healthfirst members aged 18 years and older.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-144 Advanced Primary Care Management (APCM) Services

This reimbursement policy outlines the guidelines and procedures for billing and reimbursement of Advanced Primary Care Management (APCM) services, including newly added Behavioral Health Integration (BHI) and Collaborative Care Model (CoCM) services.

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Reimbursement Policy

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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Reimbursement Policy

Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2025

Reimbursement Policy: PO-RE-139 Non-Covered Computed Heart Tomography

This reimbursement policy outlines Healthfirst's position on the non-coverage of Computed Tomography (CT) of the heart, specifically CPT code 75571, which pertains to computed tomography of the heart without contrast for quantitative coronary artery calcium scoring.

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Reimbursement Policy

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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Reimbursement Policy

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 - 2026

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 - 2024

Reimbursement Policy: PO-RE-124 Medicare Health Equity Services

This policy outlines the reimbursement guidelines for services related to the Health Equity Services framework established by the Centers for Medicare & Medicaid Services (CMS).

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-123 Intensity-Modulated Radiation Therapy

This policy outlines the reimbursement guidelines for Intensity Modulated Radiation Therapy (IMRT) services provided by healthcare providers.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-122 Pasteurized Human Donor Milk Coverage

Healthfirst provides coverage for Pasteurized Human Donor Milk (PDHM) under certain programs/lines of business.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-121 Reduction Mammaplasty

This policy outlines the reimbursement criteria for Reduction Mammaplasty procedures under Healthfirst coverage.

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Reimbursement Policy

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Reimbursement Policy: PO-RE-147 Skin Substitute Grafts and Cellular or Tissue based Products (CTPs)

Reimbursement Policy: PO-RE-146 Chronic Disease Self-Management Program (CDSMP) for Arthritis

Reimbursement Policy: PO-RE-144 Advanced Primary Care Management (APCM) Services

Reimbursement Policy: PO-RE-143 Somatosensory Evoked Potentials/Responses (SEPs/SERs)

Reimbursement Policy: PO-RE-139 Non-Covered Computed Heart Tomography

Reimbursement Policy: PO-RE-136 Brainstem Auditory Evoked Potentials and Responses (BAEPs/BAERs)

Reimbursement Policy: PO-RE-129 Medicare Physician Fee Schedule Status Indicators

Reimbursement Policy: PO-RE-127 Canalith Repositioning Procedure

Reimbursement Policy: PO-RE-124 Medicare Health Equity Services

Reimbursement Policy: PO-RE-123 Intensity-Modulated Radiation Therapy

Reimbursement Policy: PO-RE-122 Pasteurized Human Donor Milk Coverage

Reimbursement Policy: PO-RE-121 Reduction Mammaplasty

Resource Type

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Reimbursement Policy: PO-RE-147 Skin Substitute Grafts and Cellular or Tissue based Products (CTPs)

Reimbursement Policy: PO-RE-146 Chronic Disease Self-Management Program (CDSMP) for Arthritis

Reimbursement Policy: PO-RE-144 Advanced Primary Care Management (APCM) Services

Reimbursement Policy: PO-RE-143 Somatosensory Evoked Potentials/Responses (SEPs/SERs)

Reimbursement Policy: PO-RE-139 Non-Covered Computed Heart Tomography

Reimbursement Policy: PO-RE-136 Brainstem Auditory Evoked Potentials and Responses (BAEPs/BAERs)

Reimbursement Policy: PO-RE-129 Medicare Physician Fee Schedule Status Indicators

Reimbursement Policy: PO-RE-127 Canalith Repositioning Procedure

Reimbursement Policy: PO-RE-124 Medicare Health Equity Services

Reimbursement Policy: PO-RE-123 Intensity-Modulated Radiation Therapy

Reimbursement Policy: PO-RE-122 Pasteurized Human Donor Milk Coverage

Reimbursement Policy: PO-RE-121 Reduction Mammaplasty

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