Medicare AdvantageDocumentationHigh impact
Reimbursement Policies Updated in August 2026
Healthfirst·Psychiatry, Neurology, Geriatrics +1 more·Provider Update
Effective date
May 1, 2025
We identified it
Aug 6, 2026
Summary
Healthfirst updated its Psychological-Neuropsychological Testing Reimbursement Policy (PO-RE-131v2) effective May 1, 2025, requiring all claims to include an approved diagnosis code or they will be denied. The policy expanded approved diagnosis codes in October 2025 to include multiple sclerosis variants (G35.A, G35.B0, G35.B2, G35.C0, G35.C2, G35.D) and applies to Medicare Advantage, Medicare PPO, Medicaid Advantage Plus, and Integrated Benefit Dual Plans.
Action Required
IMMEDIATELY: Billing team must update claims submission workflows and billing system validation rules to require one of the approved diagnosis codes (G30-G30.9, F10.11-F19, F01-F09, F30-F39, F20-F29, G35.A, G35.B0, G35.B2, G35.C0, G35.C2, G35.D, or related codes) on ALL psychological and neuropsychological testing claims (CPT 96130, 96131, 96132, 96133, 96136, 96137, 96138, 96139, G0451) submitted to Healthfirst. BY 2025-05-01: Implement automated edits to REJECT or flag any claims lacking an approved diagnosis code before submission to prevent denials. Update provider encounter forms and billing templates to include diagnosis code requirements. Train all billing staff and providers on the approved diagnosis codes. Document the medical record to support ICD-10-CM code selection and ensure CPT/HCPCS code describes the service performed. CONSEQUENCE: Claims submitted without an approved diagnosis code will be denied reimbursement and will not be eligible for appeal based on this policy requirement.