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.

Open document

Reimbursement Policy

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

Reimbursement Policy: PO-RE-007 Intracellular Micronutrient Analysis

Micronutrients are dietary components, often referred to as vitamins and minerals, which although only required by the body in small amounts, are vital to development, disease prevention, and wellbeing.

Open document

Reimbursement Policy

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

Reimbursement Policy: PO-RE-004 Parathyroid Hormone, Phosphorus, Calcium, and Magnesium Testing

Parathyroid hormone (PTH), along with calcitriol and fibroblast growth factor 23 (FGF23), regulate calcium and phosphate homeostasis.

Open document

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.

Open document

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.

Open document

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.

Open document

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.

Open document

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.

Open external link

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).

Open document

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).

Open document

Reimbursement Policy

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

Reimbursement Policy: PO-RE-134 Prenatal and Postpartum Services Cost-Sharing Waiver

Starting January 1, 2025, a new NY State of Health (NYSOH) program under New York’s Section 1332 waiver will enhance access and affordability for pregnant and postpartum Qualified Health Plan (QHP) members.

Open document

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).

Open document

Reimbursement Policy

Resource Type

Filter

Year

Sort By

Reimbursement Policy: PO-RE-074 Remote Patient Monitoring and Remote Therapeutic Monitoring

Reimbursement Policy: PO-RE-007 Intracellular Micronutrient Analysis

Reimbursement Policy: PO-RE-004 Parathyroid Hormone, Phosphorus, Calcium, and Magnesium Testing

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

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-142 Home Sleep Test (HST)

Reimbursement Policy: PO-RE-113 Doula Services

Reimbursement Policy: PO-RE-127 Canalith Repositioning Procedure

Reimbursement Policy: PO-RE-131 Psychological and Neuropsychological Testing

Reimbursement Policy: PO-RE-134 Prenatal and Postpartum Services Cost-Sharing Waiver

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

Resource Type

Filter

Year

Sort By

Reimbursement Policy: PO-RE-074 Remote Patient Monitoring and Remote Therapeutic Monitoring

Reimbursement Policy: PO-RE-007 Intracellular Micronutrient Analysis

Reimbursement Policy: PO-RE-004 Parathyroid Hormone, Phosphorus, Calcium, and Magnesium Testing

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

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-142 Home Sleep Test (HST)

Reimbursement Policy: PO-RE-113 Doula Services

Reimbursement Policy: PO-RE-127 Canalith Repositioning Procedure

Reimbursement Policy: PO-RE-131 Psychological and Neuropsychological Testing

Reimbursement Policy: PO-RE-134 Prenatal and Postpartum Services Cost-Sharing Waiver

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

You are now navigating away from the Healthfirst website.