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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2025
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. When an individual with celiac disease ingests gluten, the body mounts an immune response that attacks the small intestine.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2025
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, 2024).

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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2025
Reimbursement Policy: PO-RE-048 Testing for Alpha-1 Antitrypsin Deficiency

Alpha 1-antitrypsin deficiency (AATD) is a genetic disease that causes deficient or defective production of the alpha-1 antitrypsin (AAT) protease inhibitor that can affect the lungs, liver, and skin (Stoller, 2024).

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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2025
Reimbursement Policy: PO-RE-046 Nerve Fiber Density Testing

Nerve fiber density testing involves analysis of skin biopsy stained with an antibody to antiprotein 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 - 2025
Reimbursement Policy: PO-RE-043 Biochemical Markers of Alzheimer Disease and Dementia

Alzheimer disease (AD) is a neurodegenerative disease defined by a gradual decline in memory, cognitive functions, gross atrophy of the brain, and accumulation of extracellular amyloid plaques and intracellular neurofibrillary tangles (Karch et al., 2014).

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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2025
Reimbursement Policy: PO-RE-040 Oral Cancer Screening and Testing

Oral cancer is defined as cancer occurring in the oral cavity between the vermilion border of the lips and the junction of the hard and soft palates or the posterior one third of the tongue. Squamous cell carcinoma is the most common type of oral cancer (Gross et al., 2024).

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Reimbursement Policy
  
Provider Alerts - Practice Guidelines and Tips - 2025
Physician Order Documentation Process for Licensed Home Care Service Agencies

Licensed Home Care Service Agencies (LHCSA) are required to obtain and document a Physician’s Order before providing Personal Care Services and Private Duty Nursing to Senior Health Partner, CompleteCare, and Medicaid Members.

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Licensed Home Care Services Agencies
Administration
Medicaid
Medicare
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2025
Additional Prior Authorization Codes Managed by EyeMed, Effective April 2025

Starting April 1, 2025, EyeMed will manage prior authorization for six new codes.

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Authorization
Dental and/or Vision
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2024
Prior Authorization Guidelines for Select CPT and HCPCS Codes Effective March 2025

Starting March 20, 2025, Healthfirst will add prior authorization requirements for selected medical services.

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Administration
Authorization
  
Provider Alerts - Claims & Billing - Practice Guidelines and Tips - 2025
Prior Authorization Guidelines for Select CPT and HCPCS Codes Effective April 2025

Starting April 6, 2025, Healthfirst will add prior authorization requirements for selected medical 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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Administration
Authorization
  
Education Events & Patient Care Resources - Patient Resource - 2020
New York State Department of Health AIDS Institute Resource Directory
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Infectious Diseases
  
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
  
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