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

Reimbursement Policy: PO-RE-106 e-Consult Visits

This document describes the eConsult visit policy Healthfirst Utilization Management follows when reimbursing for services provided by contracted providers.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-155 Non-Covered Codes – Medicare

This policy outlines the reimbursement approach for non-covered Current Procedural Terminology (CPT®) and Healthcare Common Procedure Coding System (HCPCS) codes submitted by providers participating in Healthfirst Medicare Advantage (MA) plans.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-153 Hospital Outpatient Clinic Visit – CPT/HCPCS Code G0463

This policy outlines the billing, coding, and reimbursement guidelines for hospital clinic visits billed under HCPCS code G0463.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-102 Taxonomy

A taxonomy code is a unique 10-character alphanumeric code that signifies a provider’s classification and area of specialization.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-150 Cardiac Event Detection - External Mobile Telemetry

This reimbursement policy outlines the guidelines for Mobile Cardiac Telemetry (MCT), a critical service for monitoring cardiac activity in patients with suspected or paroxysmal dysrhythmias.

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Reimbursement Policy

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

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 - 2025

Reimbursement Policy: PO-RE-149 Psychiatric Diagnostic Evaluation

This policy outlines the circumstances under which Healthfirst will reimburse claims for Psychiatric Diagnostic Evaluations, specifically utilizing CPT codes 90791 and 90792.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-148 Canes and Crutches Billing Guidelines

This policy outlines the guidelines for the reimbursement of canes and crutches provided to patients under Healthfirst coverage.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-125 Serum Testing for Evidence of Mild Traumatic Brain Injury

Traumatic brain injury (TBI) is characterized by pathologic injuries to the brain resulting from external forces or trauma.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-079 Coronavirus Testing in the Outpatient Setting

Human coronaviruses, first characterized in the 1960s, are named based on the spiked proteins located on their surface. As of 2020, seven coronaviruses are known to infect humans.

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Reimbursement Policy

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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Reimbursement Policy

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

Reimbursement Policy: PO-RE-055 Pancreatic Enzyme Testing for Acute Pancreatitis

Pancreatitis is an inflammation of pancreatic tissue and can be either acute or chronic. Pancreatic enzymes, including amylase, lipase, and trypsinogen, can be used to monitor the relative health of the pancreatic tissue.

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Reimbursement Policy

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Reimbursement Policy: PO-RE-106 e-Consult Visits

Reimbursement Policy: PO-RE-155 Non-Covered Codes – Medicare

Reimbursement Policy: PO-RE-153 Hospital Outpatient Clinic Visit – CPT/HCPCS Code G0463

Reimbursement Policy: PO-RE-102 Taxonomy

Reimbursement Policy: PO-RE-150 Cardiac Event Detection - External Mobile Telemetry

Reimbursement Policy: PO-RE-078 Telemedicine

Reimbursement Policy: PO-RE-149 Psychiatric Diagnostic Evaluation

Reimbursement Policy: PO-RE-148 Canes and Crutches Billing Guidelines

Reimbursement Policy: PO-RE-125 Serum Testing for Evidence of Mild Traumatic Brain Injury

Reimbursement Policy: PO-RE-079 Coronavirus Testing in the Outpatient Setting

Reimbursement Policy: PO-RE-063 General Inflammation Testing

Reimbursement Policy: PO-RE-055 Pancreatic Enzyme Testing for Acute Pancreatitis

Resource Type

Filter

Year

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Reimbursement Policy: PO-RE-106 e-Consult Visits

Reimbursement Policy: PO-RE-155 Non-Covered Codes – Medicare

Reimbursement Policy: PO-RE-153 Hospital Outpatient Clinic Visit – CPT/HCPCS Code G0463

Reimbursement Policy: PO-RE-102 Taxonomy

Reimbursement Policy: PO-RE-150 Cardiac Event Detection - External Mobile Telemetry

Reimbursement Policy: PO-RE-078 Telemedicine

Reimbursement Policy: PO-RE-149 Psychiatric Diagnostic Evaluation

Reimbursement Policy: PO-RE-148 Canes and Crutches Billing Guidelines

Reimbursement Policy: PO-RE-125 Serum Testing for Evidence of Mild Traumatic Brain Injury

Reimbursement Policy: PO-RE-079 Coronavirus Testing in the Outpatient Setting

Reimbursement Policy: PO-RE-063 General Inflammation Testing

Reimbursement Policy: PO-RE-055 Pancreatic Enzyme Testing for Acute Pancreatitis

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