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

MVP (NY): ABA Services Coverage update DOS 10/01/21 and thereafter

This blog post applies to physicians that are providing ABA ( Applied Behavior Analysis) services to MVP Managed Medicaid Patients.

Earlier this year MVP sent a notice to patients and Physicians that ABA (Applied Behavior Analysis) services will be covered for patients under 21 years old that have the MVP Managed Medicaid Plan, effective 10/01/2021

However, NY DOH (NY Department of Health) changed that for DOS 10/01/2021 and thereafter.

As of now ABA services are NOT COVERED FOR MVP Managed Medicaid Plans (for patients 21 years old and younger).

NY DOH will continue to cover the ABA Services for only Medicaid fee-for-service members, 21 years old and younger.

MVP is monitoring NY DOH and will make timely updates available as applicable.

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

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

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

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 and selecting Forms,
then Behavioral Health, then ABA Authorization Request.