For Providers Treating MVP Health Care Members 


Nurse Practitioners, Physician Assistants, Special Assistants, and Certified Registered Nurse Anesthetists 

During the State of Emergency: 

  • Nurse practitioners will be able to practice without a written practice agreement or collaborative relationship with a doctor or hospital 
  • Physician assistants and specialist assistants can provide medical services without oversight from a supervising physician 
  • Certified registered nurse anesthetists are permitted to administer anesthesia without the supervision of a physician 


Physical Therapists, Occupational Therapists, and Speech Therapists 

Physical therapists (PT), occupational therapists (OT), and speech therapists (ST) may render telemedicine services to MVP commercial and Medicaid Members in New York and Vermont. Certified Athletic Trainers may render telemedicine services to commercial Members in Vermont. 

During the declared State of Emergency, MVP will reimburse for PT, OT, and ST services for initial and subsequent visits for new and existing patients. PT, OT, and ST Providers may not perform telemedicine visits telephonically. Providers should only bill within their scope of practice and should not bill for physical manipulation if they are not physically manipulating the patient. All visits will count toward a Members’ annual allotment of visits. 

Claims submitted with standard CPT codes and the appropriate place of service will be paid with no cost-share for Medicaid and Commercial Members. In addition, either modifier 95 or GT should be appended to the claim as appropriate. 

 


Personal Protective Equipment (PPE) 

The New York State Department of Financial Services (DFS) recently released a Circular Letter  reminding health plans that New York State Participating Providers cannot charge patients additional fees, beyond their standard cost-share for covered services, for personal protective equipment (PPE). If your practice charged Non-Medicare MVP Members for PPE, you must fill out the PPE Survey

  • Prior Authorizations

    All Lines of Business 

    MVP has suspended prior authorization requirements for all lines of business for: 

    • Inpatient surgery and inpatient admissions to any hospital 
    • Post-acute care services after discharge from any inpatient stay (including prior authorization requirements administered by naviHealth) 
    • All Radiation Therapy and High-Tech Radiology (MRI’s, MRA’s, CT’s, Nuclear Cardiology and PET Scans) managed by eviCore*
    • All musculoskeletal codes managed by Magellan*/NIA 


    *As of June 2, 2020, Magellan and eviCore are accepting requests to obtain prior authorizations for dates of service June 19, 2020 and beyond. Pre authorization is not required for dates of service from March 20, 2020-June 18, 2020. 

     

    Commercial Fully Insured, Self-Funded Plans, and Medicaid 

    MVP will continue to perform prior authorization review for all other services, including: 

    • Outpatient elective procedures, in-office procedures, durable medical equipment, and physician administered drugs 
    • Use of out-of-network and out-of-state providers for provider office, ambulatory surgical and outpatient facility care 

    Medicare Advantage 

    MVP will continue to perform prior authorization review for all other in-network services, including outpatient elective procedures, in-office procedures, durable medical equipment, and physician administered drugs. 

  • Summary of Codes for Use During State of Emergency 

    MVP reserves the right to review all claims after the State of Emergency has been lifted to determine if proper coding was billed. 


     Commercial 
     Medicaid 
      Medicare   Notes 
    COVID-19 Diagnostic Testing  U0001
    U0002
    U0003 
    U0004 
    U0005 
    86318 
    86328 
    86408 
    86409 
    86413 
    86769 
    87426 
    87428 
    87631 
    87635 
    87636 
    87637 
    87811 
    87426 
    87428 
    0202U 
    0223U 
    0224U 
    0225U 
    0226U 
    0240U 
    0241U 

     

    ICD-10 Codes: 
    R05 
    R06.02 
    R50.9 
    U0001 
    U0002 
    U0003 
    U0004 
    U0005 
    86318 
    86328 
    86408 
    86409 
    86413 
    86769 
    87426 
    87428 
    87631 
    87635 
    87636 
    87637 
    87811 
    87426 
    87428 
    0202U 
    0223U 
    0224U 
    0225U 
    0226U 
    0240U 
    0241U 


    U0001 
    U0002 
    U0003 
    U0004 
    U0005 
    86318 
    86328 
    86408 
    86409 
    86413 
    86769 
    87426 
    87428 
    87631 
    87635 
    87636 
    87637 
    87811 
    87426 
    87428 
    0202U 
    0223U 
    0224U 
    0225U 
    0226U 
    0240U 
    0241U 

    Office, ER, UCC: 
    ICD-10 codes (1st position): 
    Z03.818 
    Z03.828 

    • No cost-share to the member 
     COVID-19 Antibody Testing  86328 
    86769 
    86328 
    86769 
    86328 
    86769 
    • No cost-share to the member 
     COVID-19 Treatment   U07.1 
    J12.82 
    M35.81 
    M35.89 
     U07.1 
    J12.82 
    M35.81 
    M35.89 
     U07.1 
    J12.82 
    M35.81 
    M35.89 
    • No cost-share to the New York Members for treatment between 4/1/2020 through 6/30/21 
    • No cost-share for Vermont Members for treatment through 7/1/2021 
    • Self-funded employer groups have the option to offer treatment coverage to their employees with no Member cost share. 
     Telemedicine Visits 

    Submit appropriate E/M or CPT code (for example 99212 or 99213) 

    POS as appropriate; GT/95 modifiers 

    Ensure only services that can be reasonably provided via telemedicine are billed 

    Submit appropriate E/M or CPT code (for example 99212 or 99213)POS as appropriate; GT/95 modifiers  99201-99215 

    POS as appropriate; GT/95 modifiers 


    E-Visits 
    MD, DO, NP, CNM bill: 
    99421-99423 


    All others bill: G2061-G2063 

    View a summary of Medicare Telemedicine Services
    • Effective 3/13/2020, no cost-share to Member during SOE 
    • Existing provider/patient relationship not necessary 
    • Included in any applicable Member benefit visit limitations 
    • VT Variation – billing as outlined can be done for visits performed visually or telephonically. 
     TeleMental Health Visits  Submit appropriate E/M or CPT code 

    POS as appropriate; GT/95 modifiers 

    May bill for ABA covered services (covered in a Commercial Member’s Subscriber Contract) for in-person visits as a TeleMental Health visit at no cost-share to the Member 
    Submit appropriate E/M or CPT code 

    POS as appropriate; GT/95 modifiers 

     OMH/OASAS Licensed Facilities: Ensure OMH attestation is on file with OMH
    Submit appropriate contracted codes 

    POS as appropriate; GT/95 modifiers 
     
    E-Visits 
    MD, DO, NP, CNM bill: 
    99421-99423 

    Providers who do not bill E/M: 
    G2061-G2063 

    View a summary of Medicare Telemedicine Services.  
    • Effective 3/13/2020, no cost-share to Member during SOE 
    • Telemental health visits may be provided as telephonic or video visits 
     Telephonic  99441 
    99442 
    99443 
    POS as appropriate Physician, NP, PA & Licensed CNM 

    Virtual Check-in: 
    G2012 
    G2010 
    99441 
    99442 
    99443 
    POS as appropriate Physician, NP, PA & Licensed CNM 
    87631 
    87635 
    U0001 
    U0002 
    U0003 
    U0004 

    Virtual Check-in: 
    G2012 
    G2010 
    • As of 3/13/2020, telephone-only codes covered at no cost-share to the Member 
    • Reimbursement is based whenever possible on rates in provider agreement 
    • Existing provider/patient relationship not necessary 


Register for COVID-19 Updates

Contact your MVP Professional Relations Representative to receive COVID-19 updates and other important notifications by email, or contact us.