Medicare AdvantageBilling CodesMedium impact
Healthfirst’s Medical, Dental, and Oral Health Coverage Reimbursement Policy
Healthfirst·Dentistry, Oral & Maxillofacial Surgery, ENT (Ear, Nose & Throat) +1 more·Provider Update
Effective date
Jan 1, 2024
We identified it
Jun 20, 2026
Summary
Healthfirst has established new billing requirements for dental services covered under medical benefits, effective January 1, 2024, with additional services covered starting January 1, 2025. Most importantly, starting July 1, 2025, all dental services billed under medical benefits will require the KX modifier, and claims must use CPT/HCPCS codes instead of CDT codes.
Action Required
By July 1, 2025: Billing team must update system to require KX modifier for all dental services billed under medical benefits to Healthfirst. Ensure all dental claims use CPT/HCPCS codes instead of CDT codes. Update billing software rules to include valid ICD-10-CM diagnosis codes that support medical necessity for covered conditions like organ transplants, cardiac procedures, cancer treatment, and jaw fractures. Claims without proper coding will be denied.