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Showing 25-36 of 771
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2025
Reimbursement Policy: PO-RE-103 Continuous Glucose Monitoring (CGM) - Billing Guidelines

Healthfirst provides reimbursement for Continuous Glucose Monitoring (CGM) devices for members diagnosed with diabetes, including Gestational diabetes, Type 1 and Type 2 diabetes.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2023
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
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2023
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 - 2023
Reimbursement Policy: PO-RE-089 Radiopharmaceuticals

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

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2023
Reimbursement Policy: PO-RE-086 Place of Service

Healthfirst will reimburse services when reported with an appropriate Place of Service (POS).

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2023
Reimbursement Policy: PO-RE-077 Photochemotherapy

Effective September 1, 2023, consistent with the American Academy of Dermatology Association and New York State, Healthfirst will update our policy regarding covered diagnoses for photochemotherapy treatment.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2024
Reimbursement Policy: PO-RE-101 After Hours and Weekend Care

After hours or weekend care (CPT®) codes represent services provided when a Healthcare Provider is required to render the services outside of regular posted office hours to treat a patient's urgent illness or condition.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2024
Reimbursement Policy: PO-RE-100 Surgical Pathology

Healthfirst has established a policy regarding the number of units payable for surgical pathology services.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2024
Reimbursement Policy: PO-RE-099 Oral Sleep Apnea Device Appliance

Healthcare Common Procedure Coding System (HCPCS) E0485 and E0486 describe oral appliances which are used for the treatment of Obstructive Sleep Apnea (OSA).

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2024
Reimbursement Policy: PO-RE-098 Monkeypox Vaccine Coverage

This policy outlines the reimbursement guidelines for coverage of the monkeypox vaccination and administration.

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Reimbursement Policy
  
Education Events & Patient Care Resources - Provider Resources - 2026
Provider Education Events

See our calendar of provider education events and register today.

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Provider Events
  
Documentation & Coding - Video - 2026
Video - Documentation and Coding of Diabetes Without Complications

This video offers guidance on proper clinical documentation and coding of Diabetes Without Complications

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Clinical Documentation Improvement
Video
  
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