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.
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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.
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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
R50.9U0001
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
0241UOffice, ER, UCC:
ICD-10 codes (1st position):
Z03.818
Z03.828- No cost-share to the member
COVID-19 Antibody Testing 86328
8676986328
8676986328
86769- No cost-share to the member
COVID-19 Treatment U07.1
J12.82
M35.81
M35.89U07.1
J12.82
M35.81
M35.89U07.1
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 MemberSubmit appropriate E/M or CPT code
POS as appropriate; GT/95 modifiers
OMH/OASAS Licensed Facilities: Ensure OMH attestation is on file with OMHSubmit 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
G201099441
99442
99443
POS as appropriate Physician, NP, PA & Licensed CNM87631
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.