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Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2025

Updated Telehealth Modifier Use

Updates to the billing requirements for telehealth services delivered through New York State Office of Mental Health (OMH)

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Reimbursement

Healthfirst Plans

Administration

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

Reimbursement Policy: PO-RE-107 Point of Care Ultrasound (PoCUS)

This document describes the policy Healthfirst follows for Point of Care Ultrasound (PoCUS). This policy is executed pursuant to applicable provisions set forth in the contracts for the products indicated above, Articles 44 and 49 of the New York State (NYS) Public Health Law (PBH), as well as applicable Federal and State statutes and regulations.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-158 Hospital Acquired Conditions (HAC)

Hospital Acquired Conditions (HACs) are serious conditions that develop during an inpatient hospital stay and are considered preventable when proper evidence-based procedures are followed.

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Reimbursement Policy

Documentation & Coding - Video - 2025

Video - Risk Adjustment 101

This video focuses on Risk Adjustment 101.

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Clinical Documentation Improvement

Video

Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2025

Update on NYS Medicaid Coverage for Therapeutic Transcranial Magnetic Stimulation (TMS)

Effective November 1, 2025, Healthfirst will provide coverage for Therapeutic Transcranial Magnetic Stimulation (TMS) for eligible Medicaid, Medicaid Advantage Plus (MAP), and Health and Recovery Plan (HARP) members diagnosed with Treatment-Resistant Major Depressive Disorder (MDD)..

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Administration

Healthfirst Plans

Medicaid

Reimbursement

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

Reimbursement Policy: PO-RE-156 Non-Covered Codes – Medicaid Managed Care and Child Health Plus

This policy outlines the reimbursement guidelines for non-covered CPT® and HCPCS codes billed to Healthfirst for Medicaid Managed Care and Child Health Plus.

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Reimbursement Policy

Provider Alerts - Pharmacy Resources & Formularies - Practice Guidelines and Tips - 2025

Obtaining Physician-Administered Drugs through a Specialty Pharmacy

As a Healthfirst provider, you can get Physician-Administered Drugs (PADs) delivered to your office at no cost through White Bagging when the medication is obtained from a Healthfirst in-network specialty pharmacy provider.

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Pharmacy

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

Reimbursement Policy: PO-RE-151 Preventative Service Codes with Medicare Status Indicator "N"

This policy outlines Healthfirst’s reimbursement methodology for preventive service codes 9938199387, 99391–99397, 99401–99404, and 99411–99412.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-114 Medical Nutrition Therapy and Counseling

This policy outlines the reimbursement guidelines for Medical Nutrition Therapy and Counseling. Healthfirst will reimburse covered Medical Nutrition Therapy and Counseling services provided by licensed professionals.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-106 e-Consult Visits

This document describes the eConsult visit policy Healthfirst Utilization Management follows when reimbursing for services provided by contracted providers.

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Reimbursement Policy

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

Reimbursement Policy: PO-RE-155 Non-Covered Codes – Medicare

This policy outlines the reimbursement approach for non-covered Current Procedural Terminology (CPT®) and Healthcare Common Procedure Coding System (HCPCS) codes submitted by providers participating in Healthfirst Medicare Advantage (MA) plans.

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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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Updated Telehealth Modifier Use

Reimbursement Policy: PO-RE-107 Point of Care Ultrasound (PoCUS)

Reimbursement Policy: PO-RE-158 Hospital Acquired Conditions (HAC)

Video - Risk Adjustment 101

Update on NYS Medicaid Coverage for Therapeutic Transcranial Magnetic Stimulation (TMS)

Reimbursement Policy: PO-RE-156 Non-Covered Codes – Medicaid Managed Care and Child Health Plus

Obtaining Physician-Administered Drugs through a Specialty Pharmacy

Reimbursement Policy: PO-RE-151 Preventative Service Codes with Medicare Status Indicator "N"

Reimbursement Policy: PO-RE-114 Medical Nutrition Therapy and Counseling

Reimbursement Policy: PO-RE-106 e-Consult Visits

Reimbursement Policy: PO-RE-155 Non-Covered Codes – Medicare

Reimbursement Policy: PO-RE-153 Hospital Outpatient Clinic Visit – CPT/HCPCS Code G0463

Search

Resource Type

Filter

Year

Sort By

Updated Telehealth Modifier Use

Reimbursement Policy: PO-RE-107 Point of Care Ultrasound (PoCUS)

Reimbursement Policy: PO-RE-158 Hospital Acquired Conditions (HAC)

Video - Risk Adjustment 101

Update on NYS Medicaid Coverage for Therapeutic Transcranial Magnetic Stimulation (TMS)

Reimbursement Policy: PO-RE-156 Non-Covered Codes – Medicaid Managed Care and Child Health Plus

Obtaining Physician-Administered Drugs through a Specialty Pharmacy

Reimbursement Policy: PO-RE-151 Preventative Service Codes with Medicare Status Indicator "N"

Reimbursement Policy: PO-RE-114 Medical Nutrition Therapy and Counseling

Reimbursement Policy: PO-RE-106 e-Consult Visits

Reimbursement Policy: PO-RE-155 Non-Covered Codes – Medicare

Reimbursement Policy: PO-RE-153 Hospital Outpatient Clinic Visit – CPT/HCPCS Code G0463

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