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

Reimbursement Policy: PO-RE-021 Testing for Diagnosis of Active or Latent Tuberculosis

Infection by Mycobacterium tuberculosis (Mtb) results in a wide range of clinical presentations dependent upon the site of infection from classic signs and symptoms of pulmonary disease (cough greater than two to three weeks' duration, lymphadenopathy, fevers, night sweats, weight loss) to silent infection with a complete absence of signs or symptoms (Lewinsohn et al., 2017).

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-016 β-Hemolytic Streptococcus Testing

Streptococcus are Gram-positive, catalase-negative bacteria that are further divided into α-hemolytic, such as S. pneumoniae and S. mutans; β-hemolytic, such as S. pyogenes (Group A), S. agalactiae (Group B), and S. dysgalactiae subsp equisimilis (Groups C and G); and γ-hemolytic, such as Enterococcus faecalis and E. faecium (Wessels, 2024).

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-014 Diagnostic Testing of Common Sexually Transmitted Infections

Sexually transmitted infections (STIs), often referred to as sexually transmitted diseases or STDs, include a variety of pathogenic bacteria, virus, and other microorganisms that are spread through sexual contact and can cause a multitude of complications if left untreated.

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

Reimbursement Policy: PO-RE-013 Urine Culture for Bacteria

Bacteriuria is the presence of bacteria in the urine. Urinary tract infections (UTIs) can occur in the urinary system and can be either symptomatic or asymptomatic.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-012 Pathogen Panel Testing

Infectious diseases can be caused by a wide range of pathogens. Conventional diagnostic methods like culture, microscopy with or without stains and immunofluorescence, and immunoassay often lack sensitivity and specificity and have long turnaround times.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-009 Diagnostic Testing of Influenza

Influenza is an acute respiratory illness caused by influenza A or B viruses resulting in upper and lower respiratory tract infection, fever, malaise, headache, and weakness.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-008 Venous and Arterial Thrombosis Risk Testing

A thrombosis, also known as a blood clot, occurs within blood vessels in the body. The two main types of thrombosis include venous thrombosis, which is when a vein is blocked due to a blood clot, and arterial thrombosis, which is when an artery is blocked due to a blood clot.

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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 (Brent, 2024).

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Reimbursement Policy

Plans & Benefits - Practice Guidelines and Tips - 2024

Healthfirst at a Glance - Leaf and Leaf Premier

Our Leaf and Leaf Premier plans offer two levels of coverage for individuals and families. They are Qualified Health Plans certified by the NYSOH marketplace.

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At a Glance

Coding - Practice Guidelines and Tips - 2024

Documentation and Coding: Benign Carcinoid Tumors, CMS-HCC_V28 Model Updates

This tip sheet is intended to assist providers and coding staff with the documentation and ICD-10-CM selection, along with the Centers for Medicare & Medicaid Services (CMS) Hierarchical Condition Category (HCC) Version 28 Model Updates, on services submitted to Healthfirst—specifically for Benign Carcinoid Tumors.

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Clinical Documentation Improvement

CMS-HCC_V28 Model Updates

Coding - Practice Guidelines and Tips - 2024

Documentation and Coding: Cholangitis, CMS-HCC_V28 Model Updates

This tip sheet is intended to assist providers and coding staff with the documentation and ICD-10-CM selection, along with the Centers for Medicare & Medicaid Services (CMS) Hierarchical Condition Category (HCC) Version 28 Model updates, on services submitted to Healthfirst—specifically for common types of Cholangitis.

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Clinical Documentation Improvement

CMS-HCC_V28 Model Updates

Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2024

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

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Reimbursement Policy: PO-RE-021 Testing for Diagnosis of Active or Latent Tuberculosis

Reimbursement Policy: PO-RE-016 β-Hemolytic Streptococcus Testing

Reimbursement Policy: PO-RE-014 Diagnostic Testing of Common Sexually Transmitted Infections

Reimbursement Policy: PO-RE-013 Urine Culture for Bacteria

Reimbursement Policy: PO-RE-012 Pathogen Panel Testing

Reimbursement Policy: PO-RE-009 Diagnostic Testing of Influenza

Reimbursement Policy: PO-RE-008 Venous and Arterial Thrombosis Risk Testing

Reimbursement Policy: PO-RE-002 Thyroid Disease Testing

Healthfirst at a Glance - Leaf and Leaf Premier

Documentation and Coding: Benign Carcinoid Tumors, CMS-HCC_V28 Model Updates

Documentation and Coding: Cholangitis, CMS-HCC_V28 Model Updates

Reimbursement Policy: PO-RE-112 By Report

Search

Resource Type

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Reimbursement Policy: PO-RE-021 Testing for Diagnosis of Active or Latent Tuberculosis

Reimbursement Policy: PO-RE-016 β-Hemolytic Streptococcus Testing

Reimbursement Policy: PO-RE-014 Diagnostic Testing of Common Sexually Transmitted Infections

Reimbursement Policy: PO-RE-013 Urine Culture for Bacteria

Reimbursement Policy: PO-RE-012 Pathogen Panel Testing

Reimbursement Policy: PO-RE-009 Diagnostic Testing of Influenza

Reimbursement Policy: PO-RE-008 Venous and Arterial Thrombosis Risk Testing

Reimbursement Policy: PO-RE-002 Thyroid Disease Testing

Healthfirst at a Glance - Leaf and Leaf Premier

Documentation and Coding: Benign Carcinoid Tumors, CMS-HCC_V28 Model Updates

Documentation and Coding: Cholangitis, CMS-HCC_V28 Model Updates

Reimbursement Policy: PO-RE-112 By Report

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