Reimbursement Policies Posted August 2026

Healthfirst has updated the below reimbursement policies in August 2026

(Updated 8/11/26)

Multiple Procedure Reduction → See Reimbursement Policy

• Explains how Healthfirst applies multiple procedure payment reductions when multiple surgical or procedural services are performed during the same operative session for the same member

Psychological and Neuropsychological Testing → See Reimbursement Policy

• Expanded the Diagnosis Code Requirements section by adding additional diagnosis codes related to multiple sclerosis
• New codes include G35.A, G35.B0, G35.B2, G35.C0, G35.C2, G35.D
• The expansion also includes updates to the Medicare-only LOB

Electromyography / Nerve Conduction Studies → See Reimbursement Policy

• Specified that electrodiagnostic testing must be ordered and supervised by a qualified physician, with documented review and diagnosis
• Updated the physician qualification criteria by removing specialty-specific references and added certification and qualification requirements for EMG testing performed by physical therapists

Vaccines for Children (VFC) → See Reimbursement Policy

• Aligned with applicable federal and New York State laws, Medicaid requirements, and NYSDOH guidance
• Expanded vaccine coverage language, added reimbursement requirements for pharmacist-administered vaccines, and incorporated new state immunization references