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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026
Reimbursement Policy: PO-RE-065 Diagnosis of Idiopathic Environmental Intolerance

Idiopathic environmental intolerance (IEI), formerly called multiple chemical sensitivity (MCS), is a subjective condition characterized by recurrent, nonspecific symptoms attributed to low levels of chemical, biologic, or physical agents in the absence of consistent objective diagnostic physical findings or laboratory tests that define an illness.

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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026
Reimbursement Policy: PO-RE-064 Immunopharmacologic Monitoring of Therapeutic Serum Antibodies

To manage loss of response due to the development of anti-drug antibodies, immunopharmacologic monitoring of circulating drug and anti-drug antibody levels has been proposed.

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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2025
Reimbursement Policy: PO-RE-063 General Inflammation Testing

Inflammatory response can occur due to tissue injury and/or various disorders, including arthritis, lupus, and infection.

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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026
Reimbursement Policy: PO-RE-078 Telemedicine

This policy outlines the guidelines for telemedicine and telehealth services eligible for reimbursement by Healthfirst.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026
Reimbursement Policy: PO-RE-132 Obstetric Billing Guidelines

This policy describes the reimbursement of obstetrical (OB) codes and the itemization of maternity care services.

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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026
Reimbursement Policy: PO-RE-171 Clinical Research Studies (Clinical Trials)

This policy establishes reimbursement guidelines for services associated with member participation in clinical research studies (clinical trials), in accordance with applicable New York State Department of Health (NYS DOH), Centers for Medicare & Medicaid Services (CMS), and Affordable Care Act (ACA) requirements.

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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026
Reimbursement Policy: PO-RE-061 Serum Biomarker Testing for Multiple Sclerosis and Related Neurological Diseases

Multiple sclerosis (MS) is the most common immune-mediated inflammatory demyelinating disease of the central nervous system (CNS) and is defined by multifocal areas of demyelination with loss of oligodendrocytes and astroglial scarring.

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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2025
Reimbursement Policy: PO-RE-060 Biomarker Testing for Autoimmune Rheumatic Disease

Systemic autoimmune rheumatic diseases (SARDs) are a diverse group of conditions that primarily affect the joints, bones, muscle, and connective tissue.

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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2025
Reimbursement Policy: PO-RE-059 Allergen Testing

Allergic disease is characterized by inappropriate or exaggerated rated immune reactions to foreign antigens (allergens) that are generally innocuous to most people, but when introduced into a genetically-predisposed individual, elicit a hypersensitivity reaction.

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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026
Reimbursement Policy: PO-RE-058 Laboratory Testing for the Diagnosis of Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) is a class of inflammatory bowel disorders comprised of two major disorders: ulcerative colitis and Crohn’s disease each with distinct pathologic and clinical characteristics.

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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026
Reimbursement Policy: PO-RE-057 Serum Testing for Hepatic Fibrosis in the Evaluation and Monitoring of Chronic Liver Disease

Chronic liver disease (CLD) refers to a wide range of liver pathologies that include inflammation (chronic hepatitis), liver cirrhosis, and hepatocellular carcinoma.

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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026
Reimbursement Policy: PO-RE-056 Gamma-glutamyl Transferase Testing in Adults

Gamma-glutamyl transferase (GGT), also known as gamma-glutamyl transpeptidase (GGTP),1,2 is an enzyme that has a half-life of between fourteen and twenty-six days and is present in the cell membrane of many different tissue types, including the heart, brain, seminal vesicles, kidneys, bile duct, spleen, and gallbladder

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Reimbursement Policy
  
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