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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026
Reimbursement Policy: PO-RE-116 CPT Category III Codes

This policy applies to all healthcare providers submitting claims to Healthfirst for services that include CPT Category III codes.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026
Reimbursement Policy: PO-RE-112 By Report

The By Report (BR) reimbursement policy outlines the guidelines for reimbursing Medicaid service codes that are designated “By Report” (“BR”) on the NYS Medicaid Physician Manual Fee Schedule and on the Ordered Ambulatory Fee Schedule.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026
Reimbursement Policy: PO-RE-108 Transportation Services

The purpose of this policy is to define the reimbursement guidelines for transportation coverage provided by Healthfirst, including ancillary services and out-of-state emergency transportation services negotiation.

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Reimbursement Policy
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2026
CMS Cell and Gene Therapy (CGT) Access Model for Casgevy™ (exagamglogene autotemcel) and Lyfgenia® (lovotibeglogene)

Medicaid Practitioner Administered Drugs Update

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Administration
Healthfirst Plans
Medicaid
  
Plans & Benefits - Practice Guidelines and Tips - 2026
Healthfirst Member ID Cards

View Healthfirst Member ID Cards at a glance.

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Healthfirst Plans
  
Documentation & Coding - Video - 2026
Video - Status Codes Indicators

This video offers guidance on Status Codes Indicators

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Clinical Documentation Improvement
Video
  
Pharmacy Resources & Formularies - Provider Resources - 2026
Prior Authorization Pharmacy Medical Benefit Grid

It is the policy of Healthfirst to require prior authorization for medical claims for all medications listed within this document. To learn more, including ways to submit prior authorization, access this resource.

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Authorization
  
Documentation & Coding - Practice Guidelines and Tips - 2025
Documentation and Coding: Chronic Post Rheumatic Arthropathy [Jaccoud]

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 Chronic Post Rheumatic Arthropathy [Jaccoud].

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Clinical Documentation Improvement
  
Documentation & Coding - Practice Guidelines and Tips - 2025
Documentation and Coding: Diabetes with Eye Complications

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 with Eye Complications.

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Clinical Documentation Improvement
  
Documentation & Coding - Practice Guidelines and Tips - 2025
Documentation and Coding: Discharge Summary

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 Discharge Summary.

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Clinical Documentation Improvement
  
Documentation & Coding - Practice Guidelines and Tips - 2025
Documentation and Coding: Major Head Injury

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 Major Head Injury.

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Clinical Documentation Improvement
  
Documentation & Coding - Practice Guidelines and Tips - 2025
Documentation and Coding: Malignant Melanoma of Face

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 Malignant Melanoma of Face.

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Clinical Documentation Improvement
  
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