Posted in MVP (NY/VT) Insurance Payer, Training, Updates

MVP Medicare Patients-KX modifier

If you are a physician that provides PT/OT/ST services to MVP Medicare Patients, then this blog post is for you!

KX modifier should NOT be used when the member did not exhaust that member’s PT/OT/ST benefits.


Claims that require a therapy cap exception and are billed with the KX modifier must:
• Qualify for the therapy cap exception
• Be medically reasonable and necessary services that require the skills of a therapist
Be justified by appropriate documentation in the medical records and would be available for review upon request

Providers: Please log on to the MVP website and verify member benefits to see that member met their annual PT/OT/ST visit cap.


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Posted in MVP (NY/VT) Insurance Payer, Pharmacy (Various Insurance Payers), Prior Authorization Insurance Carrier Updates, Training, Updates

MVP NY Medicaid Patients: coverage for Farxiga tablets

If you are a physician prescribing Farxiga for any of your patients that have NY MVP Medicaid Coverage, this blog post is for you!


Farxiga may be considered for coverage when used for one of the applicable FDA-approved indications including:

  1. For the reduction of heart failure hospitalizations in adults with Type 2 diabetes mellitus and
    established cardiovascular (CV) disease or multiple CV risk factors
  2. For the treatment of heart failure with reduced ejection fraction (NYHA classes II to IV) to
    reduce the risk of cardiovascular death and hospitalization for heart failure
  3. For the treatment of chronic kidney disease to reduce the risk of sustained eGFR decline, endstage kidney disease, cardiovascular death, and hospitalization for heart failure in those at-risk
    of disease progression

There are 2 other medications that are on the MVP Formulary that do not require prior authorization (such as Segluromet and Steglatro).


If the patient requires Farxiga then the physician needs to obtain a prior authorization.

Please follow the steps: (ALL requests have to have documentation submitted to support the use of Farxiga)

A. Visit mvphealthcare.com/Providers and Sign In to your Provider online account to use the new electronic prior authorization tool powered by Novologix®.
B. Complete the appropriate MVP prior authorization form, which can be accessed at
mvphealthcare.com/Providers, then select Forms, then under Prior Authorization, select the appropriate form in the Pharmacy section. Then, fax completed request form to MVP at 1-800-376-6373.
C. Submit a request through Surescripts.com or CoverMyMeds.com. ( covermymeds is also available on NAVINET)


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Posted in MVP (NY/VT) Insurance Payer, Training, Updates

MVP-Vermont Providers: Audio-only (telehealth) code reimbursement changes 2022

This blog applies to providers that accept MVP members and practice in Vermont.

This blog post addresses AUDIO ONLY CODES!

Effective 01/01/2022- Providers can continue to bill audio only codes, using telephone-only evaluation and management codes: 99441, 99442, 99443. These codes do not require a modifier.

However, the audio only codes that are EQUIVALENT to IN-Person visit, using audio-only must be billed with:

1.Modifier V3 – in-person services AND

2. Place of Service has to be 99 (OTHER)


Reimbursement Changes effective 03/01/2022:

1.Claims for in-person covered services performed via audio-only will be allowed at 75% of the medical provider contracted rate.

2.Behavioral Health Providers billing codes for in person covered services performed via audio[1]only will be reimbursed as outlined in their contract.


PLEASE NOTE: Other telehealth services should be provided in accordance with and billed following the guidelines outlined in the MVP Telehealth Payment Policy.


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