Category: MVP (NY/VT) Insurance Payer

Find Medical Billing and Medical Coding guidance for MVP (NY/VT) Insurance Payer.

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

MVP (NY Providers)-New Policy for : Robotic and Computer Assisted Surgery

Posted on by KR2Medical Billing

As of 06/01/2021, MVP will be changing Robotic and Computer Assisted Surgery from
medical policy to a payment policy.

MVP will no longer review Robotic and Computer Assisted Surgery as experimental/investigational.

MVP will not provide additional reimbursement based upon the type of instruments, techniques, or approach used in the surgical procedure.

MVP does not provide additional professional or technical reimbursement for use of robotic or
computer assisted instrumentation.

According to MVP reimbursement policy:

MVP provides coverage for surgical procedures that are medically necessary and meet the criteria of the policy. The use of specific surgical techniques, instrumentation, and surgical approach is left to the discretion of the surgeon.

The following codes will be included in the reimbursement of the primary procedure:

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

MVP (NY) COVID-19 Vaccine Proper Billing and Coding guidance

Posted on by KR2Medical Billing

The following medical billing and coding Guidance, for COVID-19 vaccines, ONLY applies to New York Providers.

As per MVP: ALL COVID-19 vaccines are covered for all PLANS without a member cost-share.

In order to get reimbursement, providers need to follow the proper COVID-19 vaccine billing and coding guidance.

For MVP Medicare Patients:

Providers please bill Medicare Fee-for-Service (FFS) directly for the vaccine and administration of the
vaccine to MVP Members enrolled in Medicare Advantage in 2020 and 2021. If Providers will bill the COVID-19 claims to MVP, they will be denied.

For MVP Commercial and Managed Medicaid Patients:

Since COVID-19 vaccines are provided by the government at no charge, Providers should not bill the Vaccine codes (please see below Picture 2). Instead providers should only bill the administration codes (see below Picture 1).

(Picture 1)
(Picture 2)

MVP will reimburse both In Network and Out of Network providers.

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

MVP (NY): Applied Behavior Analysis update, starting 04/15/2021

Posted on by KR2Medical Billing

As per MVP , starting 04/15/2021 they will no longer accept authorizations for ABA Services, as well as reimburse separately.

As of 04/15/2021, MVP will bundle payment for the ABA indirect services (including those ABA indirect services previously approved by MVP) should be bundled with all other assessment and treatment services and will not be reimbursed separately.

What are ABA Indirect Services?

These indirect services include the selection of treatment targets that are developed in collaboration with family members and other stakeholders, as well as the development of written protocols for treating and measuring all treatment targets.

What Code does this change apply to?

HCPCS code H0032 Please see below:

Definition w/codes
Reimbursement Policy

The MVP ABA Authorization Request form has also been updated to reflect this change. You can
locate the most up-to-date form by visiting mvphealthcare.com/providers and selecting Forms,
then Behavioral Health, then ABA Authorization Request.