Healthfirst for Providers

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

Reimbursement Policy: PO-RE-005 Diagnostic Testing of Iron Homeostasis & Metabolism

Iron, an essential nutrient with a variety of biological uses, is tightly regulated in vivo to maintain homeostasis.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-004 Parathyroid Hormone, Phosphorus, Calcium, and Magnesium Testing

Parathyroid hormone (PTH), along with calcitriol and fibroblast growth factor 23 (FGF23), regulate calcium and phosphate homeostasis.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-003 Folate Testing

Folate, or vitamin B9, is a generic term for a water-soluble vitamin obtained from the diet that is involved in the transfer of methyl groups (i.e., single carbon-containing groups) in multiple biochemical metabolic pathways, including nucleic acid biosynthesis and methionine/homocysteine metabolism.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-002 Thyroid Disease Testing

Thyroid hormones are necessary for both prenatal and postnatal development, as well as metabolic activity in adults.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-001 Vitamin D Testing

Vitamin D is a precursor to steroid hormones and plays a key role in calcium absorption and mineral metabolism.

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Reimbursement Policy

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 additional office and outpatient services billed in conjunction with Evaluation and Management (E&M) services and other qualifying encounters, when performed on the same date of services for the same member by the same provider.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-169 Medical Dental and Oral Health Coverage

Healthfirst recognizes that certain dental services are medically necessary and eligible for reimbursement when covered under a member’s medical benefit in accordance with Centers for Medicare & Medicaid Services (CMS) guidelines and applicable state and federal regulations.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-168 NYS Medicaid Breast Cancer Selective Program

This reimbursement policy outlines Healthfirst requirements for provider eligibility and claim reimbursement under the New York State (NYS) Medicaid Breast Cancer Selective Program.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-166 Non-Coverage of CPT Code 80050

Effective July 1, 2026, Healthfirst will no longer reimburse for CPT code 80050 (General Health Panel).

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-164 Magnetic Resonance Image Guided High Intensity Focused Ultrasound (MRgFUS) for Essential Tremor

Effective January 1, 2026, Healthfirst will cover Magnetic Resonance Image Guided High Intensity Focused Ultrasound (MRgFUS) under Current Procedural Terminology (CPT) code 61715.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-163 Online Digital (e-Visit) Services

This policy outlines Healthfirst’s criteria for reimbursing e-Visits, a form of asynchronous, patient-initiated communication that takes place through a secure, HIPAA-compliant digital platform, most commonly a patient portal.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-161 Tumor Treatment Field Therapy

Tumor Treatment Field Therapy (TTFT) is a non-invasive cancer treatment using alternating electric fields to inhibit cancer cell division.

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Reimbursement Policy

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Reimbursement Policy: PO-RE-005 Diagnostic Testing of Iron Homeostasis & Metabolism

Reimbursement Policy: PO-RE-004 Parathyroid Hormone, Phosphorus, Calcium, and Magnesium Testing

Reimbursement Policy: PO-RE-003 Folate Testing

Reimbursement Policy: PO-RE-002 Thyroid Disease Testing

Reimbursement Policy: PO-RE-001 Vitamin D Testing

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

Reimbursement Policy: PO-RE-169 Medical Dental and Oral Health Coverage

Reimbursement Policy: PO-RE-168 NYS Medicaid Breast Cancer Selective Program

Reimbursement Policy: PO-RE-166 Non-Coverage of CPT Code 80050

Reimbursement Policy: PO-RE-164 Magnetic Resonance Image Guided High Intensity Focused Ultrasound (MRgFUS) for Essential Tremor

Reimbursement Policy: PO-RE-163 Online Digital (e-Visit) Services

Reimbursement Policy: PO-RE-161 Tumor Treatment Field Therapy

Search

Resource Type

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Reimbursement Policy: PO-RE-005 Diagnostic Testing of Iron Homeostasis & Metabolism

Reimbursement Policy: PO-RE-004 Parathyroid Hormone, Phosphorus, Calcium, and Magnesium Testing

Reimbursement Policy: PO-RE-003 Folate Testing

Reimbursement Policy: PO-RE-002 Thyroid Disease Testing

Reimbursement Policy: PO-RE-001 Vitamin D Testing

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

Reimbursement Policy: PO-RE-169 Medical Dental and Oral Health Coverage

Reimbursement Policy: PO-RE-168 NYS Medicaid Breast Cancer Selective Program

Reimbursement Policy: PO-RE-166 Non-Coverage of CPT Code 80050

Reimbursement Policy: PO-RE-164 Magnetic Resonance Image Guided High Intensity Focused Ultrasound (MRgFUS) for Essential Tremor

Reimbursement Policy: PO-RE-163 Online Digital (e-Visit) Services

Reimbursement Policy: PO-RE-161 Tumor Treatment Field Therapy

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