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

Reimbursement Policy: PO-RE-020 Onychomycosis Testing

Onychomycosis, also known as tinea unguium, is a fungal infection of the nail typically caused by pathogenic fungal dermatophytes, such as Trichophyton rubrum, Trichophyton mentagrophytes, and Epidermophyton floccossum; onychomycosis may also be caused by yeasts, including Candida parapsilosis and Candida guilliermondii, or non-dermatophyte molds, including Neoscytalidium dimidiatum, Onychocola canadensis, the Aspergillus species, Scopulariopsis species, Alternaria species, Acremonium species, and Fusarium species.

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

Reimbursement Policy: PO-RE-018 Diagnosis of Vaginitis

Vaginitis is defined as inflammation of the vagina with symptoms of discharge, itching, and discomfort often due to a disruption of the vaginal microflora.

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

Reimbursement Policy: PO-RE-011 Lyme Disease Testing

Lyme disease is a common multisystem inflammatory disease caused by spirochetes of the family Borreliaceae transmitted through the bite of an infected tick of the genus Ixodes.

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

Reimbursement Policy: PO-RE-008 Venous and Arterial Thrombosis Risk Testing

A thrombosis, also known as a blood clot, occurs within blood vessels in the body.

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

Reimbursement Policy: PO-RE-002 Thyroid Disease Testing

Thyroid hormones are necessary for both prenatal and postnatal development, as well as metabolic activity in adults.

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

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.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-141 Interprofessional Consultation for Behavioral Health Services

This reimbursement policy outlines the guidelines for billing and reimbursement of interprofessional consultations in behavioral health services as established by the Centers for Medicare & Medicaid Services (CMS) starting in 2025.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-103 Continuous Glucose Monitoring (CGM) - Billing Guidelines

Healthfirst provides reimbursement for Continuous Glucose Monitoring (CGM) devices for members diagnosed with diabetes, including Gestational diabetes, Type 1 and Type 2 diabetes.

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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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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-019 Human Immunodeficiency Virus (HIV)

Human immunodeficiency virus (HIV) is an RNA retrovirus that infects human immune cells, specifically CD4 cells, causing progressive deterioration of the immune system ultimately leading to acquired immune deficiency syndrome (AIDS) characterized by susceptibility to opportunistic infections and HIV-related cancers.

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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.

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Reimbursement Policy: PO-RE-020 Onychomycosis Testing

Reimbursement Policy: PO-RE-018 Diagnosis of Vaginitis

Reimbursement Policy: PO-RE-011 Lyme Disease Testing

Reimbursement Policy: PO-RE-008 Venous and Arterial Thrombosis Risk Testing

Reimbursement Policy: PO-RE-002 Thyroid Disease Testing

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

Reimbursement Policy: PO-RE-141 Interprofessional Consultation for Behavioral Health Services

Reimbursement Policy: PO-RE-103 Continuous Glucose Monitoring (CGM) - Billing Guidelines

Reimbursement Policy: PO-RE-095 Anesthesia Services

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

Reimbursement Policy: PO-RE-019 Human Immunodeficiency Virus (HIV)

Reimbursement Policy: PO-RE-007 Intracellular Micronutrient Analysis

Resource Type

Filter

Year

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Reimbursement Policy: PO-RE-020 Onychomycosis Testing

Reimbursement Policy: PO-RE-018 Diagnosis of Vaginitis

Reimbursement Policy: PO-RE-011 Lyme Disease Testing

Reimbursement Policy: PO-RE-008 Venous and Arterial Thrombosis Risk Testing

Reimbursement Policy: PO-RE-002 Thyroid Disease Testing

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

Reimbursement Policy: PO-RE-141 Interprofessional Consultation for Behavioral Health Services

Reimbursement Policy: PO-RE-103 Continuous Glucose Monitoring (CGM) - Billing Guidelines

Reimbursement Policy: PO-RE-095 Anesthesia Services

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

Reimbursement Policy: PO-RE-019 Human Immunodeficiency Virus (HIV)

Reimbursement Policy: PO-RE-007 Intracellular Micronutrient Analysis

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