Posted in NY Providers, Payer Updates, Payers and CPT reinbursement, Training, Updates

MVP Health Plans: reimbursement of sick E&M codes billed w/preventative codes -05/01/23

According to the latest announcement MVP Health Plan will change the reimbursement of sick E/M codes when they are billed on the same day as a preventative codes.

This policy applies to Primary Care Physicians.

According to the new reimbursement policy the sick E&M codes will be reimbursed at 50% of allowable amount if the codes are billed on the same date of service as the preventative codes.

The reimbursement will be applied with or without the modifier 25 present.

Policy applies to the following codes:

Preventive medicine services are represented in evaluation and management (E/M) codes 99381–99429. These E/M codes may be reported by any qualified physician or other qualified healthcare professional.

Preventative cpt codes 99381–99397 for comprehensive preventive evaluations are age-specific, beginning with infancy and ranging through patients age 65 and over for both new and established office patients.

E&M codes may include: 99202-99205, 99212-99215

For more information please refer to MVP Evaluation and Management (E&M) policy.

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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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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: