Compliance, Regulatory & Policies

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

Reimbursement Policy: PO-RE-023 Diabetes Mellitus Testing

Diabetes describes several heterogeneous diseases in which various genetic and environmental factors can result in the progressive loss of β-cell mass and/or function that manifests clinically as hyperglycemia.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-013 Urine Culture for Bacteria

Bacteriuria is the presence of bacteria in the urine. Urinary tract infections (UTIs) can occur in the urinary system and can be either symptomatic or asymptomatic

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Reimbursement Policy

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

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 - 2026

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 - 2026

Reimbursement Policy: PO-RE-177 CCBHC Provider Billing Guidance – QHP (UB-04 Billing)

This reimbursement policy describes Healthfirst's reimbursement requirements for Certified Community Behavioral Health Clinic (CCBHC) services provided to eligible members enrolled in Healthfirst Qualified Health Plan (QHP) product.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-174 Routine and Non- Routine Foot Care

This reimbursement policy establishes coverage and reimbursement requirements for routine and non-routine foot care services across applicable Healthfirst lines of business.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-170 Additional Office and Outpatient Services Billed with Evaluation and Management (E&M)

This policy outlines Healthfirst's reimbursement methodology for Evaluation and Management (E/M) services and additional office and outpatient services billed on the same date of service.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-117 Fertility and Preservation Services

This reimbursement policy outlines Healthfirst's reimbursement requirements for infertility and fertility preservation services.

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Reimbursement Policy

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

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 - 2026

Reimbursement Policy: PO-RE-135 PCP Scope of Reimbursement

The purpose of this policy is to outline the reimbursement guidelines for services provided by Primary Care Physicians (PCPs).

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-086 Place of Service

Healthfirst will reimburse services when reported with an appropriate Place of Service (POS).

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Reimbursement Policy

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

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

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Reimbursement Policy: PO-RE-023 Diabetes Mellitus Testing

Reimbursement Policy: PO-RE-013 Urine Culture for Bacteria

Reimbursement Policy: PO-RE-012 Pathogen Panel Testing

Reimbursement Policy: PO-RE-130 Discarded Drugs and Biologicals Billing Guidelines

Reimbursement Policy: PO-RE-177 CCBHC Provider Billing Guidance – QHP (UB-04 Billing)

Reimbursement Policy: PO-RE-174 Routine and Non- Routine Foot Care

Reimbursement Policy: PO-RE-170 Additional Office and Outpatient Services Billed with Evaluation and Management (E&M)

Reimbursement Policy: PO-RE-117 Fertility and Preservation Services

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

Reimbursement Policy: PO-RE-135 PCP Scope of Reimbursement

Reimbursement Policy: PO-RE-086 Place of Service

Reimbursement Policy: PO-RE-085 Chest X-Rays for Lung Cancer Screening

Resource Type

Filter

Year

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Reimbursement Policy: PO-RE-023 Diabetes Mellitus Testing

Reimbursement Policy: PO-RE-013 Urine Culture for Bacteria

Reimbursement Policy: PO-RE-012 Pathogen Panel Testing

Reimbursement Policy: PO-RE-130 Discarded Drugs and Biologicals Billing Guidelines

Reimbursement Policy: PO-RE-177 CCBHC Provider Billing Guidance – QHP (UB-04 Billing)

Reimbursement Policy: PO-RE-174 Routine and Non- Routine Foot Care

Reimbursement Policy: PO-RE-170 Additional Office and Outpatient Services Billed with Evaluation and Management (E&M)

Reimbursement Policy: PO-RE-117 Fertility and Preservation Services

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

Reimbursement Policy: PO-RE-135 PCP Scope of Reimbursement

Reimbursement Policy: PO-RE-086 Place of Service

Reimbursement Policy: PO-RE-085 Chest X-Rays for Lung Cancer Screening

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