Compliance, Regulatory & Policies

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

Reimbursement Policy: PO-RE-092 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 - 2026

Reimbursement Policy: PO-RE-093 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 - 2026

Reimbursement Policy: PO-RE-173 CCBHC Provider Billing Guidance (UB-04 Billing)

This reimbursement policy describes Healthfirst's reimbursement requirements for Certified Community Behavioral Health Clinic (CCBHC) services provided to eligible Healthfirst members.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-172 Multiple Procedure Reduction

Healthfirst applies multiple procedure payment reductions when multiple surgical or procedural services are performed during the same operative session for the same member.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-142 Home Sleep Test (HST)

Home Sleep Tests (HSTs) are designed to help diagnose sleep disordered breathing conditions in a home-setting.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-081 Vaccines For Children (VFC)

Healthfirst administers reimbursement for Vaccines for Children (VFC) services in accordance with applicable federal and New York State (NYS) laws, regulations, Medicaid requirements, and VFC program guidance, including requirements issued by the Centers for Disease Control and Prevention (CDC), the Centers for Medicare & Medicaid Services (CMS), the New York State Department of Health (NYSDOH), and other applicable federal or state authorities.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-131 Psychological and Neuropsychological Testing

Effective May 1st, 2025, Healthfirst implemented a new reimbursement policy for Psychological-Neuropsychological testing.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-140 Electromyography and Nerve Conduction Studies

This policy outlines the guidelines for reimbursing Electromyography (EMG) and Nerve Conduction Studies (NCS) performed to diagnose, evaluate, or manage peripheral nerve and neuromuscular disorders.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-109 Vaccine Administration

This policy establishes Healthfirst's reimbursement guidelines for vaccine administration services.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-067 Evaluation of Dry Eyes

Dry eye disease (dysfunctional tear syndrome, DED) is defined by the Dry Eye Workshop II as “a multifactorial disease of the ocular surface characterized by a loss of homeostasis of the tear film, and accompanied by ocular symptoms, in which tear film instability and hyperosmolarity, ocular surface inflammation and damage, and neurosensory abnormalities play etiological roles.”

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-066 Prescription Medication and Illicit Drug Testing in the Outpatient Setting

Abuse of both prescription and illicit drugs is extremely common.

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Reimbursement Policy

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

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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Reimbursement Policy

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Reimbursement Policy: PO-RE-092 Ultrasound Diagnostic Procedures

Reimbursement Policy: PO-RE-093 Obstetrical Ultrasound Procedures

Reimbursement Policy: PO-RE-173 CCBHC Provider Billing Guidance (UB-04 Billing)

Reimbursement Policy: PO-RE-172 Multiple Procedure Reduction

Reimbursement Policy: PO-RE-142 Home Sleep Test (HST)

Reimbursement Policy: PO-RE-081 Vaccines For Children (VFC)

Reimbursement Policy: PO-RE-131 Psychological and Neuropsychological Testing

Reimbursement Policy: PO-RE-140 Electromyography and Nerve Conduction Studies

Reimbursement Policy: PO-RE-109 Vaccine Administration

Reimbursement Policy: PO-RE-067 Evaluation of Dry Eyes

Reimbursement Policy: PO-RE-066 Prescription Medication and Illicit Drug Testing in the Outpatient Setting

Reimbursement Policy: PO-RE-060 Biomarker Testing for Autoimmune Rheumatic Disease

Resource Type

Filter

Year

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Reimbursement Policy: PO-RE-092 Ultrasound Diagnostic Procedures

Reimbursement Policy: PO-RE-093 Obstetrical Ultrasound Procedures

Reimbursement Policy: PO-RE-173 CCBHC Provider Billing Guidance (UB-04 Billing)

Reimbursement Policy: PO-RE-172 Multiple Procedure Reduction

Reimbursement Policy: PO-RE-142 Home Sleep Test (HST)

Reimbursement Policy: PO-RE-081 Vaccines For Children (VFC)

Reimbursement Policy: PO-RE-131 Psychological and Neuropsychological Testing

Reimbursement Policy: PO-RE-140 Electromyography and Nerve Conduction Studies

Reimbursement Policy: PO-RE-109 Vaccine Administration

Reimbursement Policy: PO-RE-067 Evaluation of Dry Eyes

Reimbursement Policy: PO-RE-066 Prescription Medication and Illicit Drug Testing in the Outpatient Setting

Reimbursement Policy: PO-RE-060 Biomarker Testing for Autoimmune Rheumatic Disease

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