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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2025
Reimbursement Policy: PO-RE-029 Testosterone Testing

Testosterone is a naturally occurring lipophilic androgen hormone that is produced by both males and females for various functions.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2025
Reimbursement Policy: PO-RE-036 Immune Cell Function Assay

Immune cell function assays involve measurement of peripheral blood lymphocyte response (intracellular ATP levels, proliferation) following stimulation to assess the degree of functionality of the cell-mediated immune response (Buttgereit et al., 2000)

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2025
Reimbursement Policy: PO-RE-038 Immunohistochemistry

Immunohistochemistry (IHC) is a very sensitive and specific staining technique that uses anatomical, biochemical, and immunological methods to identify cells, tissues, and organisms by the interaction of target antigens with highly specific monoclonal antibodies and visualization though the use of a biochemical tag or label (Fitzgibbons et al., 2014)

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2025
Reimbursement Policy: PO-RE-065 Diagnosis of Idiopathic Environmental Intolerance

Idiopathic environmental intolerance (IEI), formerly called multiple chemical sensitivity (MCS), is a subjective condition characterized by recurrent, nonspecific symptoms attributed to low levels of chemical, biologic, or physical agents in the absence of consistent objective diagnostic physical findings or laboratory tests that define an illness (AAAAI, 1999; ACOEM, 1999; Black & Temple, 2024).

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2025
Reimbursement Policy: PO-RE-079 Coronavirus Testing in the Outpatient Setting

Human coronaviruses, first characterized in the 1960s, are named based on the spiked proteins located on their surface.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2025
Reimbursement Policy: PO-RE-082 Testing of Homocysteine Metabolism-Related Conditions

Homocystinuria is a metabolic condition in which the body is unable to properly process certain amino acids, resulting in an abnormal accumulation of homocysteine and its metabolites in the blood and urine (NIH, 2023).

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2025
Reimbursement Policy: PO-RE-133 Therapeutic Drug Monitoring for 5-Fluorouracil

Chemotherapeutic agents are incredibly potent drugs, often carrying cytotoxic side effects. Most chemotherapeutic drugs have a steep dose-response relationship and a narrow therapeutic index (a range where an agent provides therapeutic effect without major side effects).

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Reimbursement Policy
  
Pharmacy Resources & Formularies - Provider Resources - 2025
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
  
Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2025
Prior Authorization Guidelines for Select CPT and HCPCS Codes Effective July 2025

Healthfirst is adding new prior authorization requirements for selected medical services.

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Administration
Authorization
Healthfirst Plans
  
Provider Alerts - Policy, Billing, or Coverage Update - 2025
Medicare Enrollment Guidelines for Medicaid Members with End Stage Renal Disease (ESRD)

The New York State Department of Health requires Medicaid members diagnosed with End Stage Renal Disease (ESRD) to apply for Medicare.

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Administration
Medicaid
Medicare
  
Provider Alerts - Education Events & Patient Care Resources - Practice Guidelines and Tips - 2025
Help Off-Exchange Members Renew Their Coverage

New York State will resume standard annual recertification procedures for off-exchange Medicaid, HARP, LIP, CC, and SHP members.

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Administration
Medicaid
Recertification
  
Plans & Benefits - Practice Guidelines and Tips - 2025
Healthfirst Plans at a Glance

Healthfirst has health plans made for New Yorkers.

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At a Glance
  
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