There are no updates for Radiation Oncology Program Codes.
The following codes will be added to EviCore Prior Auth list, effective 03/01/2021.
MVP NY Update: more codes are added to eviCore prior auth list-03/01/21
Tag: #MVP
MVP (NY/VT) & Reimbursement Policy for 95165 (Allergen Serum Preparation), 01/01/2021
According the MVP Provider Manual, effective 01/01/2021 MVP (Vermont and NY) will only reimburse for the following units (specify quantity):
First Year:
Max # of units per claim/DOS is 40
Max # of units per calendar year is 150
Subsequent Years:
Max # of units per claims/DOS is 30
Max# of units per calendar year is 30
This is a BIG CHANGE from the previous reimbursement quantities. As recent as July 1,2020- MVP used to reimburse for 150 units for the first year and 120 units for the subsequent years.
Please see below: JULY 01/2020 version
January 1/2021 version:
#allergenimmunothearpy #allergist #allergy #allergy serum #asthma
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NY STATE DFS PPE (99072) letter- patients are not responsible.
Update: Oxford/UHC/ NYSHIP (Empire Plan) and 1199 DO NOT PAY FOR THIS CODE.
As of 09/08/20-there is a new CPT code 99072 became available for PPE.
Definition 99072:
Additional supplies, materials, and preparation time required and provided by the physician or other qualified health care professional and/or clinical staff over and above those usually included in an office visit or other service(s), when performed during a nationally declared public health emergency due to respiratory transmitted infectious disease.
Coding Guidelines:
Code 99072 is to be reported only once per in-person patient encounter per provider identification number, regardless of the number of services rendered at that encounter.
Code 99072 is designed to capture the following practice expense factors:
- Time over what is included in the primary service of clinical staff time to conduct a pre-visit phone call to screen the patient (symptom check), provide instructions on social distancing during the visit, check patients for symptoms upon arrival, apply and remove personal protective equipment, and additional cleaning of the examination/procedure/imaging rooms, equipment and supplies
- Three surgical masks
- Additional cleaning supplies (e.g., hand sanitizers, disinfectant wipes)
HOWEVER, as of 09/09/2020 as per NY STATE DOH there was a letter sent out to providers from various insurance payers: Anthem BCBS (Empire), MVP, EmblemHealth warned providers not to collect any copay, coinsurance for PPE.
IF the patient was charged for PPE, the provider has to refund they should issue a refund to members immediately and contact your Empire Network Services representative to report the following:
- Member(s) impacted
- Total refunded to member(s)
- The refund process
Below are the links to the announcements that were went to the NY providers from above mentioned insurance payers/ NY DFS Letter :
- EmblemHealth Coronavirus (COVID-19) Update | EmblemHealth
- Empire BCBS (Anthem) NY Providers Communication
- MVP FAX Provider Communication
- NY Provider Communications New York Department of Financial Services (“DFS”)
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