Posted in EmblemHealth NY, NY Providers, Training, Updates

EmblemHealth/Connecticare: Telehealth Reimbursement Policy Update for 2022

If you are a provider that accepts patients with EmblemHealth and/or Connecticare Insurance this blog post is for you!

This policy applies to Emblemhealth/Connecticare Commercial, Medicare and Medicaid Members.


Effective 01/01/2022- EmblemHealth/Connecticare has updated their telehealth policy. The following update was added:


Effective 06/01/2022- changes effect modifiers:

Want to learn more? Please click here to see the whole telehealth policy.


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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.


Find this type of information useful? Follow my blog for all of medical billing/coding guideline changes, reimbursement/medical policy updates, and anything else related to healthcare field.


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

MVP (NY/VT): COVID-19 Treatment and Virtual Care, Cost-Share Update

Below policy will apply to MVP plans that are located in New York and Vermont.

New York Virtual Care Cost-Share: Telemedicine

For MVP Medicare Advantage Plans- MVP will continue to apply the cost sharing waver for audio/visual and audio only until the DOS (dates of service) Dec 31,2021.

For MVP Commercial Plans- Starting August 1,2021 and thereafter the patients will have to pay their “in-person visit” cost-share for audio/visual and audio only visits according to their plan details.


Vermont Virtual Care Cost-Share: Telemedicine

For MVP Medicare Advantage Plans- MVP will continue to apply the cost sharing waver for audio/visual and audio only until the DOS (dates of service) Dec 31,2021.

For MVP Commercial Plans- Starting August 1,2021 and thereafter the patients will have to pay their “in-person visit” cost-share for audio/visual and audio only visits according to their plan details.


New York Covid-19 Treatment member Cost-Share:

Effective August 1, 2021, MVP will no longer waive the cost-share for COVID-19 treatment.


***Vermont Covid-19 Treatment member Cost-Share: ***

MVP will continue to cover COVID-19 treatment in full until March 1, 2022 as is required by
Vermont Rules.



COVID-19 Testing Member Cost-Share: NY &VT

MVP will continue to cover COVID-19 testing in full in New York and Vermont


COVID -19 Testing Coding and Billing Corner:

As of January 1, 2021 claims billed with a diagnosis code Z03.818 in conjunction with a COVID19 testing procedure code will be denied

MVP will retain the expanded set of codes eligible for telehealth, consistent with CMS guidance, and will continue to monitor state and federal guidelines and regulations. In addition, MVP supports continued telehealth reimbursement and is currently reviewing coding guidance.


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