Effective 7/1/26 for any DOS and thereafter Healthfirst will align with both CMS and NYS Medicaid- and will no longer cover code 80050-general health panel.

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Bundling:

A comprehensive metabolic panel (80053)

A complete blood count (CBC) with differential (85025)

Thyroid-stimulating hormone (TSH) (84443)

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This effects the following plans:

Summary

Podcast

I. Policy Description

Definitions

Policy Scope

Reimbursement Guidelines

Adjudication and Appeal Process

II. Applicable Codes

III. Definitions

IV. Related Policies

V. Reference Materials

VI. Revision History

Disclaimer

Non-Coverage of CPT Code 80050

Subject:

Non-Coverage of CPT Code 80050

Policy Number:

PO-RE-166v1

Effective Date:

07/01/2026

Last Approval Date:

03/16/2026

I. Policy Description

Effective July 1, 2026, Healthfirst will no longer reimburse for CPT code 80050 (General Health Panel). This decision aligns with current coverage determinations from:

• • Centers for Medicare & Medicaid Services (CMS)
• • New York State (NYS) Medicaid

Both CMS and NYS Medicaid do not separately cover CPT 80050. In accordance, Healthfirst will deny all claims submitted with this code

This policy applies to the following Lines of Business (LOB):

• Child Health Plus (CHP)

• Essential Plan (EP)

• Integrated Benefit Dual Plan (IB-Dual)

• Managed Long Term Care Plan (MLTCP – Senior Health Partners)

• Medicaid Managed Care (MMC)

• Medicaid Advantage Plus/MAP (CompleteCare)

• Medicare Advantage HMO

• Qualified Health Plan (QHP)

• Medicare PPO

• Personal Wellness Plan (HARP)

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