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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026
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 - 2026
Reimbursement Policy: PO-RE-006 Vitamin B12 and Methylmalonic Acid Testing

Vitamin B12, also known as cobalamin, is a water-soluble vitamin required for proper red blood cell formation, key metabolic processes, neurological function, and DNA regulation and synthesis.

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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 - 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-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
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026
Reimbursement Policy: PO-RE-160 Medicare Diabetes Prevention Program (MDPP)

The purpose of this policy is to establish compliant and consistent reimbursement and billing guidelines for the Medicare Diabetes Prevention Program (MDPP).

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026
Reimbursement Policy: PO-RE-157 ESRD Oral-Only Renal Dialysis Services – Drugs & Biologicals

Effective January 1, 2025, in accordance with CMS updates to the ESRD Prospective Payment System (PPS), oral-only renal dialysis service drugs and biologicals, specifically phosphate binders, will be incorporated into the ESRD PPS bundled payment model.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2025
Reimbursement Policy: PO-RE-153 Hospital Outpatient Clinic Visit – CPT/HCPCS Code G0463

This policy outlines the billing, coding, and reimbursement guidelines for hospital clinic visits billed under HCPCS code G0463.

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Reimbursement Policy
  
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