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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2025
Reimbursement Policy: PO-RE-027 Cardiovascular Disease Risk Assessment

Cardiovascular risk assessment comprises the means and processes to predict the probability of developing a cardiovascular disease.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2025
Reimbursement Policy: PO-RE-012 Pathogen Panel Testing

Infectious diseases can be caused by a wide range of pathogens. Conventional diagnostic methods like culture, microscopy with or without stains and immunofluorescence, and immunoassay often lack sensitivity and specificity and have long turnaround times.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2025
Reimbursement Policy: PO-RE-003 Folate Testing

Folate, or vitamin B9, is a generic term for a water-soluble vitamin obtained from the diet that is involved in the transfer of methyl groups (i.e., single carbon-containing groups) in multiple biochemical metabolic pathways, including nucleic acid biosynthesis and methionine/homocysteine metabolism.

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Reimbursement Policy
  
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 - 2025
Reimbursement Policy: PO-RE-137 Appropriate Use of Manifestation Diagnosis Codes

Healthfirst is committed to ensuring accurate and compliant claims submission through the correct use of diagnosis coding, specifically emphasizing the appropriate application of Manifestation Codes.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2025
Reimbursement Policy: PO-RE-115 Digital Mental Health Treatment (DMHT) Device

A Digital Mental Health Treatment (DMHT) device is a device similar to a mobile device that allows billing practitioners to provide behavioral health services in conjunction with ongoing behavioral health care treatment.

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Reimbursement Policy
  
Provider Alerts - Compliance, Regulatory & Policies - Practice Guidelines and Tips - 2025
Important Notice Regarding U.S. Department of Justice Regulations on Sensitive Personal Data

The United States Department of Justice (DOJ) has issued new regulations titled the “Final Rule on Preventing Access to U.S. Sensitive Personal Data and United States Government-Related Data by Countries of Concern”, codified at 28 C.F.R. Part 202.

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Healthfirst Plans
Administration
  
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-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 - 2025
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 - 2025
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
  
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