Compliance, Regulatory & Policies

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

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 - 2025

Reimbursement Policy: PO-RE-139 Non-Covered Computed Heart Tomography

This reimbursement policy outlines Healthfirst's position on the non-coverage of Computed Tomography (CT) of the heart, specifically CPT code 75571, which pertains to computed tomography of the heart without contrast for quantitative coronary artery calcium scoring.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-136 Brainstem Auditory Evoked Potentials and Responses (BAEPs/BAERs)

This policy outlines the reimbursement guidelines for Brainstem Auditory Evoked Potentials (BAEPs) and Brainstem Auditory Evoked Responses (BAERs) testing, in accordance with Local Coverage Determination (LCD) L34975 and Local Coverage Article A56773, Jurisdiction H and L.

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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 global obstetrical (OB) codes and the itemization of maternity care services.

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Reimbursement Policy

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

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

Effective May 1, 2025, Healthfirst will implement a new reimbursement policy for Psychological-Neuropsychological testing. This policy is aligned with Local Coverage Determination L34520 and Local Coverage Article A57780 R-10-01-2024 (Jurisdiction N).

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Reimbursement Policy

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

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 - 2025

Reimbursement Policy: PO-RE-129 Medicare Physician Fee Schedule Status Indicators

The purpose of this reimbursement policy is to define the payment criteria for covered services as designated by the Centers for Medicare and Medicaid Services (CMS), particularly those classified as "always bundled" when billed alongside another physician's procedure or service.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-127 Canalith Repositioning Procedure

Healthfirst adheres to the Centers for Medicare & Medicaid Services (CMS) guidelines for Canalith Repositioning Procedures. This policy outlines the reimbursement criteria and procedure for the CPT code 95992, which is designated for the therapeutic management of benign paroxysmal positional vertigo (BPPV).

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Reimbursement Policy

Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2024

Reimbursement Policy: PO-RE-124 Medicare Health Equity Services

This policy outlines the reimbursement guidelines for services related to the Health Equity Services framework established by the Centers for Medicare & Medicaid Services (CMS).

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-123 Intensity-Modulated Radiation Therapy

This policy outlines the reimbursement guidelines for Intensity Modulated Radiation Therapy (IMRT) services provided by healthcare providers.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-122 Pasteurized Human Donor Milk Coverage

Healthfirst provides coverage for Pasteurized Human Donor Milk (PDHM) under certain programs/lines of business.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-121 Reduction Mammaplasty

This policy outlines the reimbursement criteria for Reduction Mammaplasty procedures under Healthfirst coverage.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-139 Non-Covered Computed Heart Tomography

Reimbursement Policy: PO-RE-136 Brainstem Auditory Evoked Potentials and Responses (BAEPs/BAERs)

Reimbursement Policy: PO-RE-132 Obstetric Billing Guidelines

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

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

Reimbursement Policy: PO-RE-129 Medicare Physician Fee Schedule Status Indicators

Reimbursement Policy: PO-RE-127 Canalith Repositioning Procedure

Reimbursement Policy: PO-RE-124 Medicare Health Equity Services

Reimbursement Policy: PO-RE-123 Intensity-Modulated Radiation Therapy

Reimbursement Policy: PO-RE-122 Pasteurized Human Donor Milk Coverage

Reimbursement Policy: PO-RE-121 Reduction Mammaplasty

Resource Type

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Year

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

Reimbursement Policy: PO-RE-139 Non-Covered Computed Heart Tomography

Reimbursement Policy: PO-RE-136 Brainstem Auditory Evoked Potentials and Responses (BAEPs/BAERs)

Reimbursement Policy: PO-RE-132 Obstetric Billing Guidelines

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

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

Reimbursement Policy: PO-RE-129 Medicare Physician Fee Schedule Status Indicators

Reimbursement Policy: PO-RE-127 Canalith Repositioning Procedure

Reimbursement Policy: PO-RE-124 Medicare Health Equity Services

Reimbursement Policy: PO-RE-123 Intensity-Modulated Radiation Therapy

Reimbursement Policy: PO-RE-122 Pasteurized Human Donor Milk Coverage

Reimbursement Policy: PO-RE-121 Reduction Mammaplasty

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