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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2024
Reimbursement Policy: PO-RE-109 Vaccine Administration

Healthfirst acknowledges the importance of vaccination in promoting public health and aims to align its reimbursement policies with the latest Centers for Disease Control (CDC) recommendations for coding, cost-sharing, and pricing of vaccine administration services. These guidelines outline the reimbursement policy for vaccination services provided by healthcare providers within the Healthfirst network.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2024
Reimbursement Policy: PO-RE-110 Preventive Care Services (Commercial Plans)

Healthfirst recognizes the importances of preventive care in promoting overall health and well-being. To support our members in maintaining good health and preventing illnesses, we provide coverage for a range of preventive services in accordance with this policy.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2024
Reimbursement Policy: PO-RE-105 Removal of Impacted Cerumen

The removal of impacted cerumen (earwax) is the extraction of hardened or accumulated cerumen from the external auditory canal by mechanical methods (irrigation or debridement).

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2023
Reimbursement Policy: PO-RE-088v1 National Drug Code Billing Requirements

This policy describes the National Drug Code (NDC) information that is required on professional and outpatient facility drug claims that are reported for reimbursement.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2023
Reimbursement Policy: PO-RE-089v1 Radiopharmaceuticals

Healthfirst has updated its reimbursement policy for radiopharmaceuticals commonly used for myocardial perfusion imaging studies.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2023
Reimbursement Policy: PO-RE-092v1 Ultrasound Diagnostic Procedures

Healthfirst will no longer provide reimbursement for CPT 76856 (Ultrasound, pelvic [non-obstetric], real time with image documentation; complete) or CPT 76857 Ultrasound, pelvic [non-obstetric], real time with image documentation; limited or follow-up) when billed with CPT 76830 (Transvaginal ultrasound) unless extenuating circumstances are present to validate the necessity of both studies.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2023
Reimbursement Policy: PO-RE-093v1 Obstetrical Ultrasound Procedures

Healthfirst has implemented the following reimbursement policy regarding the billing of CPT 76817 (Ultrasound, pregnant uterus, real time with image documentation, transvaginal) in conjunction with CPT 76801-76812 (Ultrasound, pregnant uterus, real time with image documentation, transabdominal)

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2024
Reimbursement Policy: PO-RE-083 General Ophthalmological Exams

This reimbursement policy outlines the guidelines for the reimbursement of comprehensive ophthalmological exams and intermediate ophthalmological exams for service codes 92012 and 92014.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2024
Reimbursement Policy: PO-RE-091 Trigger Point Injections

Healthfirst aims to ensure that its reimbursement policy for trigger point injections aligns with state and national industry standards. This policy outlines the limitations and guidelines for the reimbursement of trigger point injections provided to Healthfirst members.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2024
Reimbursement Policy: PO-RE-084 Radiological Chest Examination

Healthfirst will no longer reimburse for chest X-Ray procedures with service codes 71045 and 71046 unless there is a diagnosis of pertinent signs, symptoms, or diseases.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2024
Reimbursement Policy: PO-RE-085 Chest X-Rays for Lung Cancer Screening

This policy outlines the reimbursement guidelines for chest X-ray procedures performed for the sole purpose of lung cancer screening or assessing nicotine use/dependence.

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Reimbursement Policy
  
Provider Alerts - Compliance, Regulatory & Policies - Practice Guidelines and Tips - 2024
New State Requirements for Provider Compliance Programs

New York State has made changes to provider requirements for starting and maintaining compliance programs.

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Quality and Compliance
  
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