Healthfirst for Providers

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

Reimbursement Policy: PO-RE-089 Radiopharmaceuticals

Healthfirst has updated its reimbursement policy for radiopharmaceuticals commonly used for myocardial perfusion imaging studies. This

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-092 Ultrasound Diagnostic Procedures

Healthfirst will no longer provide reimbursement for CPT 76856 (Ultrasound, pelvic [non-obstetric], real time with image documentation; complete) or CPT 76857 Ultrasound, pelvic [non-obstetric], real time with image documentation; limited or follow-up) when billed with CPT 76830 (Transvaginal ultrasound) unless extenuating circumstances are present to validate the necessity of both studies.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-093 Obstetrical Ultrasound Procedures

Healthfirst has implemented the following reimbursement policy regarding the billing of CPT 76817 (Ultrasound, pregnant uterus, real time with image documentation, transvaginal) in conjunction with CPT 76801-76812 (Ultrasound, pregnant uterus, real time with image documentation, transabdominal)

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Reimbursement Policy

Provider Alerts - Claims & Billing - Practice Guidelines and Tips - 2026

Prior Authorization Requirements for Select Codes Starting November 30, 2026

Effective November 30, 2026, Healthfirst will require prior authorization requirements for several CPT codes.

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Documentation & Coding - Video - 2026

Video - Documentation and Coding of Vascular Dementia

This video offers guidance on proper clinical documentation and coding of Vascular Dementia

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Clinical Documentation Improvement

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

Reimbursement Policy: PO-RE-170 Additional Office and Outpatient Services Billed with Evaluation and Management (E&M)

This policy outlines Healthfirst's reimbursement methodology for Evaluation and Management (E/M) services and additional office and outpatient services billed on the same date of service.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-173 CCBHC Provider Billing Guidance (UB-04 Billing)

This reimbursement policy describes Healthfirst's reimbursement requirements for Certified Community Behavioral Health Clinic (CCBHC) services provided to eligible Healthfirst members.

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Reimbursement Policy

Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2026

Important Update to Electronic Remittance Advice (ERA) Distribution Logic

Healthfirst is updating the logic used to route ERA transactions.

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Reimbursement

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

Reimbursement Policy: PO-RE-172 Multiple Procedure Reduction

Healthfirst applies multiple procedure payment reductions when multiple surgical or procedural services are performed during the same operative session for the same member.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-142 Home Sleep Test (HST)

Home Sleep Tests (HSTs) are designed to help diagnose sleep disordered breathing conditions in a home-setting.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-081 Vaccines For Children (VFC)

Healthfirst administers reimbursement for Vaccines for Children (VFC) services in accordance with applicable federal and New York State (NYS) laws, regulations, Medicaid requirements, and VFC program guidance, including requirements issued by the Centers for Disease Control and Prevention (CDC), the Centers for Medicare & Medicaid Services (CMS), the New York State Department of Health (NYSDOH), and other applicable federal or state authorities.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-131 Psychological and Neuropsychological Testing

Effective May 1st, 2025, Healthfirst implemented a new reimbursement policy for Psychological-Neuropsychological testing.

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Reimbursement Policy

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Reimbursement Policy: PO-RE-089 Radiopharmaceuticals

Reimbursement Policy: PO-RE-092 Ultrasound Diagnostic Procedures

Reimbursement Policy: PO-RE-093 Obstetrical Ultrasound Procedures

Prior Authorization Requirements for Select Codes Starting November 30, 2026

Video - Documentation and Coding of Vascular Dementia

Reimbursement Policy: PO-RE-170 Additional Office and Outpatient Services Billed with Evaluation and Management (E&M)

Reimbursement Policy: PO-RE-173 CCBHC Provider Billing Guidance (UB-04 Billing)

Important Update to Electronic Remittance Advice (ERA) Distribution Logic

Reimbursement Policy: PO-RE-172 Multiple Procedure Reduction

Reimbursement Policy: PO-RE-142 Home Sleep Test (HST)

Reimbursement Policy: PO-RE-081 Vaccines For Children (VFC)

Reimbursement Policy: PO-RE-131 Psychological and Neuropsychological Testing

Search

Resource Type

Filter

Year

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Reimbursement Policy: PO-RE-089 Radiopharmaceuticals

Reimbursement Policy: PO-RE-092 Ultrasound Diagnostic Procedures

Reimbursement Policy: PO-RE-093 Obstetrical Ultrasound Procedures

Prior Authorization Requirements for Select Codes Starting November 30, 2026

Video - Documentation and Coding of Vascular Dementia

Reimbursement Policy: PO-RE-170 Additional Office and Outpatient Services Billed with Evaluation and Management (E&M)

Reimbursement Policy: PO-RE-173 CCBHC Provider Billing Guidance (UB-04 Billing)

Important Update to Electronic Remittance Advice (ERA) Distribution Logic

Reimbursement Policy: PO-RE-172 Multiple Procedure Reduction

Reimbursement Policy: PO-RE-142 Home Sleep Test (HST)

Reimbursement Policy: PO-RE-081 Vaccines For Children (VFC)

Reimbursement Policy: PO-RE-131 Psychological and Neuropsychological Testing

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