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Provider Alerts - Practice Guidelines and Tips - 2025
2025 Medicare Diabetes Prevention Program (MDPP) Expanded Model Updates

Effective Jan 1, 2025, The Centers for Medicare & Medicaid Services (CMS) finalized several updates to the Medicare Diabetes Prevention Program (MDPP).

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Reimbursement
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Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2025
Updated Telehealth Modifier Use

Updates to the billing requirements for telehealth services delivered through New York State Office of Mental Health (OMH)

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Healthfirst Plans
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Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2025
Electronic Consultation (eConsult) Reimbursement

Reimbursement Updates for eConsults

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Administration
Reimbursement
Healthfirst Plans
  
Provider Alerts - Practice Guidelines and Tips - 2025
Concurrent Review Updates for Select Child and Family Treatment and Support Services (CFTSS)

Effective September 1, 2025, Healthfirst will implement Concurrent review for Psychosocial Rehabilitation (PSR) and Community Psychiatric Supports and Treatment (CPST) services under the Children and Family Treatment and Support Services (CFTSS) benefit.

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Provider Alerts - Practice Guidelines and Tips - 2025
FAQ for Concurrent Review Updates for Select Child and Family Treatment and Support Services (CFTSS)

Answers to frequently asked questions (FAQs) regarding Healthfirst implementation of concurrent review for Psychosocial Rehabilitation (PSR) and Community Psychiatric Supports and Treatment (CPST) services under the Children and Family Treatment and Support Services (CFTSS) benefit, effective September 1, 2025.

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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-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
  
Education Events & Patient Care Resources - Provider Resources - 2025
Provider Education Events

See our calendar of provider education events and register today.

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Provider Events
  
Education Events & Patient Care Resources - Video - 2025
Provider Education Events - Recorded Video Sessions

Browse our previously recorded webinars and training sessions.

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Provider Events
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2025
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
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2025
Reimbursement Policy: PO-RE-068 Prenatal Screening (Nongenetic)

Prenatal screening encompasses any testing done to determine the health status of the pregnant individual and/or fetus.

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