Medicare AdvantageCoverageHigh impact
Provider Updates for July 2026
Healthfirst·NY·Provider Update
Effective date
Jul 1, 2026
We identified it
Jul 2, 2026
Summary
Effective July 1, 2026, Healthfirst will no longer reimburse CPT code 80050 (General Health Panel) across all lines of business, aligning with CMS and NYS Medicaid non-coverage determinations. All claims submitted with this code will be denied. Providers may bill individual component codes (80053, 85025, 85027, 85004, 85007, 85009, 84443) separately if medically necessary and properly documented.
Action Required
By June 30, 2026: Billing team must update billing software and claim submission rules to deny/reject all CPT 80050 claims for Healthfirst plans (CHP, EP, IB-Dual, MLTCP, MMC, MAP, Medicare Advantage HMO, QHP, Medicare PPO, HARP). Update encounter forms and provider education materials to instruct providers to bill component codes (80053, 85025, 85027, 85004, 85007, 85009, 84443) individually when clinically appropriate instead of using the bundled panel code. Implement system edits to automatically deny CPT 80050 with denial reason code for non-coverage. Train billing staff and providers on component billing requirements and medical necessity documentation standards. Communicate policy to all providers submitting claims to Healthfirst. Failure to comply will result in claim denials and potential recoupment of payments.