COVID-19 Public Health Emergency (PHE) Unwind Updates
As the COVID-19 Public Health Emergency (PHE) ends, MVP will continue to monitor the situation carefully and take proactive measures to continue to protect the health and safety of MVP Members, employees, and Providers.
We will continue to work in accordance with the guidelines provided by the Centers for Disease Control and Prevention (CDC), the World Health Organization (WHO), and with both New York and Vermont state departments overseeing the needs of the communities we serve.
Please note, MVP is abiding by guidance put forth by all regulating bodies and will provide coverage accordingly. As regulatory dates change, so will the dates associated with MVP coverage outlined below. MVP will email or fax updates to Providers and will update this page accordingly.
FDA-approved COVID-19 vaccines will continue to be covered without cost-share for Members when administered by in-network Providers. When COVID-19 vaccine doses are provided by the government without charge, MVP will only reimburse for the administration of the vaccine.
For Medicare Products, FDA-approved COVID-19 vaccines administered by in-network Providers shall be covered without cost-share for Members under Medicare Part B benefit as a preventive vaccine; this coverage has been made permanent through CARES Act. For OON administrations, cost-share will be applied effective May 12, 2023. There are no out-of-country vaccine coverage benefits.
COVID-19 Diagnostic and Antibody Testing
In compliance with state and federal regulations, plan standard cost-share will apply to COVID-19 diagnostic lab tests and associated covered services to treat COVID-19 diagnosis or symptoms.
Over the counter COVID-19 testing will no longer be covered by MVP. Please refer to NYRx for Medicaid and HARP coverage.
Pre-op COVID-19 diagnostic testing is no longer covered for all Members. MVP will not reimburse separately for diagnostic pre-op testing for MVP commercial and Medicaid Members as it will be considered global to the surgery, as are all other pre-op tests. Providers billing for MVP Medicare Members will be reimbursed based on CMS Guidelines.
Plan standard cost-share will apply for COVID-19 treatment for any site of service, including inpatient hospitalizations and emergency room visits, for New York State and Vermont fully insured health plans and Medicare health plans.
For Medicare products
- Oral Antivirals: coverage of COVID-19 oral antivirals under emergency use authorization by in-network Providers shall continue under Part D (not Part B) through December 31, 2024, and with $0 cost-share to Members (when prescribed by in-network Providers); For OON, cost-share will be applied effective May 12, 2023
- Approved Monoclonal Antibodies: coverage of COVID-19 monoclonal antibodies under emergency use authorization by in-network Providers shall continue under Part B (not Part D) through 12/31/23 and with $0 cost-share to Members (when obtained by in-network Providers); For OON, cost-share will be applied effective May 12, 2023
MVP will continue to cover services provided via Telehealth with applicable cost share. In addition, Audio-only services billed using accepted CPT codes will continue to be covered in accordance with state and federal laws.
- For Commercial and Medicare Products, MVP will follow the CMS Telehealth guidelines
- For Government Program Products (Managed Medicaid, CHP and HARP), MVP will follow NYS Medicaid guidelines
- For OMH licensed and designated Providers, MVP will follow OMH Telehealth guidelines
Authorized Providers who deliver telehealth and telemedicine services must use communication technologies and/or platforms that comply with the HIPAA rules.
For additional information, please review the MVP Telehealth Payment Policy.
All Federal and state Executive Orders regarding utilization management have expired. Please refer to the Utilization and Case Management section of the MVP Provider Policies and Payment Policies for further information.