Effective 5/1/23 MVP insurance payer will start to reimburse 50% for the E&M code that represents the sick visit and is billed on the same day as the preventative E&M code.
The providers should expect this reduction to apply to the code even if the modifier 25 is appended on the sick E&M code.
This update in reimbursement applies to both NY and VT providers.
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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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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:
- For the reduction of heart failure hospitalizations in adults with Type 2 diabetes mellitus and
established cardiovascular (CV) disease or multiple CV risk factors
- 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
- 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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