Healthfirst's Provider Updates for November 2026 contains reimbursement policy PO-RE-045v6, Biomarkers for Myocardial Infarction and Chronic Heart Failure, which the source lists with an effective date of November 1, 2026. The policy states that measuring quantitative cardiac troponin meets coverage criteria up to four times within the first 72 hours after initial presentation with signs and symptoms of acute coronary syndrome, while AST, CKMB, CK, LDH, myoglobin and ST2 analysis in the outpatient setting do not meet coverage criteria. The revision history says the June 3, 2026 review updated the background, guidelines and references and did not necessitate any modifications to coverage criteria.
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01Already effective November 1, 2026: Check the current applicability of policy PO-RE-045v6, Biomarkers for Myocardial Infarction and Chronic Heart Failure, and review its coverage criteria, which state which biomarker tests meet and do not meet coverage criteria.
02Confirm each member's benefit coverage at the time of the request, because the policy says application of the coverage criteria depends on it.
03Check the policy's Applicable State and Federal Regulations section for Medicare and Medicaid specifications.
04Per the policy disclaimer, failure to follow proper coding, billing and reimbursement guidelines could result in denial and/or recoupment of the claim payment.
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