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

Reimbursement Policy: PO-RE-151 Preventative Service Codes with Medicare Status Indicator "N"

This policy outlines Healthfirst’s reimbursement methodology for preventive service codes 9938199387, 99391–99397, 99401–99404, and 99411–99412.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-114 Medical Nutrition Therapy and Counseling

This policy outlines the reimbursement guidelines for Medical Nutrition Therapy and Counseling. Healthfirst will reimburse covered Medical Nutrition Therapy and Counseling services provided by licensed professionals.

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Reimbursement Policy

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-156 Non-Covered Codes – Medicaid Managed Care and Child Health Plus

This policy outlines the reimbursement guidelines for non-covered CPT® and HCPCS codes billed to Healthfirst for Medicaid Managed Care and Child Health Plus.

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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

Provider Alerts - Policy, Billing, or Coverage Update - 2025

Prior Authorization Guidelines for Select Services Effective February 1, 2026

Starting February 1, 2026, Healthfirst will add prior authorization requirements for selected vision services. These changes are part of Healthfirst’s ongoing responsibility to evaluate its medical policies compared to the latest scientific evidence and specialty society guidance.

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Authorization

Provider Alerts - Pharmacy Resources & Formularies - Policy, Billing, or Coverage Update - 2025

Reimbursement Update for Contrast Agents Prescribed to Medicaid Members

To align with the New York State Medicaid Pharmacy Program policies, Healthfirst will no longer reimburse any contrast agents used for radiological testing for members enrolled in Medicaid Managed Care (MMC) or Personal Wellness Plans (HARP).

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Pharmacy

Medicaid

Provider Forms - Form - 2025

Provider Attestation for OTC Plus Special Supplemental Benefits

Submit this form so your patient can use their OTC benefits for food and utilities.

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Forms

Documentation & Coding - Practice Guidelines and Tips - 2025

Documentation and Coding: Diabetes Mellitus

This tip sheet is intended to assist providers and coding staff with the documentation and ICD-10-CM selection on services submitted to Healthfirst—specifically for Diabetes Mellitus.

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Clinical Documentation Improvement

Documentation & Coding - Practice Guidelines and Tips - 2025

Documentation and Coding: Pulmonary Fibrosis

This tip sheet is intended to assist providers and coding staff with the documentation and ICD-10-CM selection on services submitted to Healthfirst —specifically for common types of Pulmonary Fibrosis.

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Clinical Documentation Improvement

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Reimbursement Policy: PO-RE-151 Preventative Service Codes with Medicare Status Indicator "N"

Reimbursement Policy: PO-RE-114 Medical Nutrition Therapy and Counseling

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

Reimbursement Policy: PO-RE-156 Non-Covered Codes – Medicaid Managed Care and Child Health Plus

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

Prior Authorization Guidelines for Select Services Effective February 1, 2026

Reimbursement Update for Contrast Agents Prescribed to Medicaid Members

Provider Attestation for OTC Plus Special Supplemental Benefits

Documentation and Coding: Diabetes Mellitus

Documentation and Coding: Pulmonary Fibrosis

Search

Resource Type

Filter

Year

Sort By

Reimbursement Policy: PO-RE-151 Preventative Service Codes with Medicare Status Indicator "N"

Reimbursement Policy: PO-RE-114 Medical Nutrition Therapy and Counseling

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

Reimbursement Policy: PO-RE-156 Non-Covered Codes – Medicaid Managed Care and Child Health Plus

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

Prior Authorization Guidelines for Select Services Effective February 1, 2026

Reimbursement Update for Contrast Agents Prescribed to Medicaid Members

Provider Attestation for OTC Plus Special Supplemental Benefits

Documentation and Coding: Diabetes Mellitus

Documentation and Coding: Pulmonary Fibrosis

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