Compliance, Regulatory & Policies

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

Reimbursement Policy: PO-RE-179 Speech-Language Pathology Treatment Services

Effective January 1, 2027, CPT code 92507 is deleted and may no longer be reported for speech-language pathology treatment services.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-176 Specimen Collection

This policy memorializes Healthfirst’s reimbursement guidelines for specimen collection services performed in connection with a primary visit or other primary reimbursable healthcare service.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-074 Remote Patient Monitoring and Remote Therapeutic Monitoring

The purpose of this policy is to outline the reimbursement guidelines for Remote Patient Monitoring (RPM) services and Remote Therapeutic Monitoring (RTM) services offered by Healthfirst.

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Reimbursement Policy

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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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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Reimbursement Policy

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-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 - 2026

Reimbursement Policy: PO-RE-105 Removal of Impacted Cerumen

The removal of impacted cerumen (earwax) refers to the extraction of hardened or accumulated earwax from the external auditory canal using mechanical techniques, such as irrigation, lavage, or debridement.

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Reimbursement Policy

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

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 - 2026

Reimbursement Policy: PO-RE-175 Childhood Vaccine Counseling

Healthfirst reimburses qualified providers for childhood vaccine counseling services provided to Healthfirst Medicaid and Child Health Plus members under 21 years of age in accordance with New York State Medicaid requirements.

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Reimbursement Policy

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

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 - 2026

Reimbursement Policy: PO-RE-080 Colorectal Cancer Screening

Colorectal cancer (CRC) is the term used to describe the development of cancer in the colon or the rectum.

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Reimbursement Policy

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Reimbursement Policy: PO-RE-179 Speech-Language Pathology Treatment Services

Reimbursement Policy: PO-RE-176 Specimen Collection

Reimbursement Policy: PO-RE-074 Remote Patient Monitoring and Remote Therapeutic Monitoring

Reimbursement Policy: PO-RE-171 Clinical Research Studies (Clinical Trials)

Reimbursement Policy: PO-RE-132 Obstetric Billing Guidelines

Reimbursement Policy: PO-RE-078 Telemedicine

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

Reimbursement Policy: PO-RE-105 Removal of Impacted Cerumen

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

Reimbursement Policy: PO-RE-175 Childhood Vaccine Counseling

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

Reimbursement Policy: PO-RE-080 Colorectal Cancer Screening

Resource Type

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Year

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Reimbursement Policy: PO-RE-179 Speech-Language Pathology Treatment Services

Reimbursement Policy: PO-RE-176 Specimen Collection

Reimbursement Policy: PO-RE-074 Remote Patient Monitoring and Remote Therapeutic Monitoring

Reimbursement Policy: PO-RE-171 Clinical Research Studies (Clinical Trials)

Reimbursement Policy: PO-RE-132 Obstetric Billing Guidelines

Reimbursement Policy: PO-RE-078 Telemedicine

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

Reimbursement Policy: PO-RE-105 Removal of Impacted Cerumen

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

Reimbursement Policy: PO-RE-175 Childhood Vaccine Counseling

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

Reimbursement Policy: PO-RE-080 Colorectal Cancer Screening

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