Posted in #reimbursement, Payer Updates, Payers and CPT reinbursement, Updates

North Carolina Medicaid- self collected HPV test info.

In March of 2024- FDA apprpved a self collecting HPV test.

It is a self collected HPV testing in a healthcare setting- patient uses a swab or brush in a private room (like in a doctor’s office) to collect their own vaginal sample for cervical cancer screening.

As of May 1st 2025, NC Medicaid added a new code 87624 or 87626.

87624- (2020) (infectious agent detection by nucleic acid [DNA or RNA]; Human Papillomavirus [HPV], high risk types) is eligible for reimbursement only when billed with ICD-10-CM diagnosis code Z11.51 

87626- Infectious agent detection by nucleic acid (DNA or RNA); Human Papillomavirus (HPV), separately reported high-risk types (eg, 16, 18, 31, 45, 51, 52) and high-risk pooled result(s)


Eligibility:

-Only ages 30–64 years for routine cervical cancer screening

-No symptoms of abnormal bleeding, no active menstrual bleeding or use of vaginal products within 2 days

-Not HIV positive

-No history of cervical cancer

-Asymptomatic and eligible for primary HPV testing


Follow up recommendations based on the results:

-HPV negative – Repeat screening in 3 years

-HPV 16 or HPV 18 detected – Refer or return visit for colposcopy

-HPV types 56/59/66 detected with extended genotyping – Retest in 1 year at clinician’s discretion

-Other HPV detected with extended (or without) extended genotyping – Return visit for clinician-collected cervical specimen for cytology or dual stain


Resources:

1.American Cancer Society:  -https://cervicalroundtable.org/wp-content/uploads/2024/10/Self-Collection-Clinician-Communication-Guide.pdf

2. National Cancer Institute guidelines: https://dceg.cancer.gov/news-events/news/2025/self-collection-hpv-testing

3. NC Medicaid-

https://medicaid.ncdhhs.gov/blog/2025/05/02/changes-clinical-coverage-policy-1e-7-family-planning-services


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Posted in #Medicareadvantage, MVP (NY/VT) Insurance Payer, Prior Authorization Insurance Carrier Updates, Updates

MVP to end its relationship with naviHealth, Inc

Currently naviHealth, Inc handles Utilization and Case/Care Management for post-acute services—including Skilled Nursing Facility (SNF), Inpatient Rehabilitation Facility (IRF), and Home Health—for MVP Medicare Advantage, DualAccess, and DualAccess Complete Members.

However, MVP and naviHealth, Inc will end their contract as of Dec 31st 2025.

Starting on Jan 1,2025 MVP will process these requests in house.

More information to come in Nov 2025.


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Posted in MVP (NY/VT) Insurance Payer, NY Medicaid EHR incentive program, NY Providers, Payers and CPT reinbursement, Updates

MVP postpartum program incentive payments: NY providers!

Are you any of these following providers in NY?

OB/GYN Family Medicine Certified Nurse Mid-wives Nurse Practitioner – Family Health

Then this blog post is for you!

NY DOH established an additional payment (to global OBGYN bundled payment) for providers that complete a person-centered postpartum visit— including a depression screening—within 12 weeks of delivery, as per ACOG/AAP guidelines.


In order to qualify for this additional payment the postpartum services need to be related to deliveries that occurred from July 1, 2024, through March 31, 2025.

Coding that qualify for this program are:CPT II Code 59430 or 0503F

Please bill these codes with $0


This program only applies to Managed Medicaid Care Plan type.


The additional payment amount is $125.

The payments are maid quaterly basis.


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