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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2023

Reimbursement Policy: PO-RE-046 Nerve Fiber Density Testing

Nerve fiber density testing involves analysis of skin biopsy stained with an antibody to anti protein gene product 9.5 (Wilkinson et al., 1989) which avidly stains all axons (Dalsgaard et al., 1989).

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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2023

Reimbursement Policy: PO-RE-049 Metabolite Markers of Thiopurines Testing

Thiopurines are a class of purine antimetabolite immunomodulators with diverse clinical applications in treatment of autoimmune disorders, transplant rejection, and acute lymphoblastic leukemia (Belmont, 2022).

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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2023

Reimbursement Policy: PO-RE-051 Celiac Disease Testing

Celiac disease is a hereditary, chronic autoimmune disorder triggered by the ingestion of gluten, a protein found in wheat, rye, and barley.

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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2023

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 - 2023

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 (Peppercorn & Cheifetz, 2023).

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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2023

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 - 2023

Reimbursement Policy: PO-RE-053 Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Fecal Microbiota Transplant Testing

Intestinal dysbiosis is defined as a disruption or imbalance of the intestinal microbial ecology (Guinane & Cotter, 2013).

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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2023

Reimbursement Policy: PO-RE-054 Fecal Calprotectin Testing in Adults

Calprotectin is a small calcium-binding protein found in high concentration in the cytosol of neutrophils (Fagerhol et al., 1980) and to a lesser extent monocytes and macrophages (Hsu et al., 2009).

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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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Claims & Billing - Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2021

Reimbursement Policy: Anesthesia Start and Stop Times

Healthfirst requires that providers include the start time, stop time, and duration of anesthesia in the note segment of the 5010 claim form.

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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-089v1 Radiopharmaceuticals

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

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Reimbursement Policy

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Reimbursement Policy: PO-RE-046 Nerve Fiber Density Testing

Reimbursement Policy: PO-RE-049 Metabolite Markers of Thiopurines Testing

Reimbursement Policy: PO-RE-051 Celiac Disease Testing

Reimbursement Policy: PO-RE-057 Serum Testing for Hepatic Fibrosis in the Evaluation and Monitoring of Chronic Liver Disease

Reimbursement Policy: PO-RE-058 Laboratory Testing for the Diagnosis of Inflammatory Bowel Disease

Reimbursement Policy: PO-RE-061 Serum Biomarker Testing for Multiple Sclerosis and Related Neurological Diseases

Reimbursement Policy: PO-RE-053 Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Fecal Microbiota Transplant Testing

Reimbursement Policy: PO-RE-054 Fecal Calprotectin Testing in Adults

Reimbursement Policy: PO-RE-093v1 Obstetrical Ultrasound Procedures

Reimbursement Policy: Anesthesia Start and Stop Times

Reimbursement Policy: PO-RE-092v1 Ultrasound Diagnostic Procedures

Reimbursement Policy: PO-RE-089v1 Radiopharmaceuticals

Resource Type

Filter

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Reimbursement Policy: PO-RE-046 Nerve Fiber Density Testing

Reimbursement Policy: PO-RE-049 Metabolite Markers of Thiopurines Testing

Reimbursement Policy: PO-RE-051 Celiac Disease Testing

Reimbursement Policy: PO-RE-057 Serum Testing for Hepatic Fibrosis in the Evaluation and Monitoring of Chronic Liver Disease

Reimbursement Policy: PO-RE-058 Laboratory Testing for the Diagnosis of Inflammatory Bowel Disease

Reimbursement Policy: PO-RE-061 Serum Biomarker Testing for Multiple Sclerosis and Related Neurological Diseases

Reimbursement Policy: PO-RE-053 Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Fecal Microbiota Transplant Testing

Reimbursement Policy: PO-RE-054 Fecal Calprotectin Testing in Adults

Reimbursement Policy: PO-RE-093v1 Obstetrical Ultrasound Procedures

Reimbursement Policy: Anesthesia Start and Stop Times

Reimbursement Policy: PO-RE-092v1 Ultrasound Diagnostic Procedures

Reimbursement Policy: PO-RE-089v1 Radiopharmaceuticals

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