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

MVP-Vermont Providers: Audio-only (telehealth) code reimbursement changes 2022

This blog applies to providers that accept MVP members and practice in Vermont.

This blog post addresses AUDIO ONLY CODES!

Effective 01/01/2022- Providers can continue to bill audio only codes, using telephone-only evaluation and management codes: 99441, 99442, 99443. These codes do not require a modifier.

However, the audio only codes that are EQUIVALENT to IN-Person visit, using audio-only must be billed with:

1.Modifier V3 – in-person services AND

2. Place of Service has to be 99 (OTHER)


Reimbursement Changes effective 03/01/2022:

1.Claims for in-person covered services performed via audio-only will be allowed at 75% of the medical provider contracted rate.

2.Behavioral Health Providers billing codes for in person covered services performed via audio[1]only will be reimbursed as outlined in their contract.


PLEASE NOTE: Other telehealth services should be provided in accordance with and billed following the guidelines outlined in the MVP Telehealth Payment Policy.


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Posted in #Medicareadvantage, #unitedhealthcare, Training, Updates

UHC Commercial and Exchange Plans: update to Radiology Prior Auth List

As of December 1,2021 the following codes will be added to the radiology prior authorization list. These codes will require an authorization for DOS 12/01/2021 and thereafter.

The prior authorization for these codes WILL NOT APPLY TO The following situations: if the advanced imaging is done in-

  • Emergency room
  • Urgent care center
  • Observation unit
  • Inpatient stay

In case you missed it:

In June 2021, UHC also added more Radiology and Cardiology codes on the Prior Authorization List. These codes apply to UnitedHealthCare Community Plan, Medicare Advantage, commercial and exchange Plans


For complete details on the radiology protocol, refer to the current UnitedHealthcare Administrative Guide


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Posted in BCBS Empire NY, Training, Updates

BCBS NY: Reimbursement Policies Updates for 2021

1.Reimbursement Policy: Consultations (Professional)

Effective 10/31/2021- Empire BCBS policy “Documentation and Reporting Guidelines for Consultations” policy will be renamed as “Consultations” Please remember that this policy will be updated to align with CMS guidance- DOES NOT ALLOW reimbursement for inpatient (99251-99255) or outpatient (99241-99245) consultation codes and requires providers to bill the appropriate office visit Evaluation and Management (E&M) code for consultation services

To read this full reimbursement policy, please click here.


2. NEW Reimbursement Policy (facility): Non-patient Laboratory Services

Effective 10/01/2021- Empire BCBS will implement a new reimbursement policy- Non-Patient Laboratory Services. This policy states that Empire does not allow reimbursement for non-patient laboratory services when reported on a UB-04 with bill type 014X unless provider, state, federal or CMS and/or requirements indicate otherwise

To read this full reimbursement policy, please click here.


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