MVP Health Care® (MVP) continues to monitor the coronavirus disease 2019 (COVID-19) situation carefully and is taking proactive measures to protect the health and safety of MVP members, employees, providers, and our community. We are working 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.

MVP is committed to keeping providers up to date regarding changing guidelines and policies. Below is a summary of changes made during this State of Emergency.

Receive updates as they are announced. Send a request to MVPFastFax@mvphealthcare.com to receive email updates. MVP will email or fax updates to providers and will update this page accordingly.

During this unprecedented time, we appreciate your partnership, and your patience.

  • Summary of Codes for Use During State of Emergency

    Commercial Medicaid Medicare Notes
    COVID-19 Diagnostic Testing Lab claims:
    U0001
    U0002
    87635
     
    In-Office:
    87631

    ICD-10 Codes:
    R05
    R06.02
    R50.9

    Lab claims:
    U0001
    U0002
    87635
     
    In-Office:
    87631
    Lab claims:
    U0001
    U0002
    87635
     
    In-Office:
    87631

    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 U07.1 U07.1
    • No cost-share to the member for treatment between 4/1/2020 through 5/31/2020
    • 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 codePOS 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

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


  • COVID-19 Testing & Treatment

    Diagnostic Testing

    In compliance with state and federal regulations, MVP will not apply a cost-share* to testing for COVID-19, including any fees associated with an office, Emergency Department (ED), or Urgent Care Center (UCC) to an in-network Provider for the purpose of getting tested for COVID-19 including tests performed by hospital and commercial labs (i.e., LabCorp and Quest Diagnostics).

    The following CPT codes should be used for COVID-19 testing:

    CPT Code Description
    U0001 Reported for coronavirus testing using the Centers for Disease Control and Prevention (CDC) 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel.
    U0002 Reported for validated non-CDC laboratory tests for SARS-CoV-2/2019-nCoV (COVID-19).
    87635 Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique

    Claims billed with the following ICD-10 codes in the first position for office, ED, or UCC visits that are for the primary purpose of testing will not apply a cost-share:

    • Z03.818
    • Z20.828

    In addition, effective 3/13/2020, the following codes will be covered at no cost-share for commercial members:

    • R05
    • R06.02
    • R50.9

    COVID 19 Antibody Testing

    Only a small number of the serologic assays to identify antibodies to SARS-CoV-2are officially approved by the FDA. Providers are strongly encouraged to only use the tests officially approved by the FDA. Information about the tests is found on the FDA’s website.

    If performed, use the following codes to ensure member cost-share is waived*:

    CPT Code Description
    86328 Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single step method (eg, reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (COVID-19)
    86769 Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (COVID-19)

    Providers should be aware of the following when ordering serologic assays for COVID-19:

    • Serologic tests should not be used as the sole basis to diagnose or exclude SARS-CoV-2 infection.
    • Negative results do not rule out SARS-CoV-2 infection, particularly in those who have been in contact with the virus.
    • Positive results may be due to past or present infection with non-SARS-CoV-2 coronavirus strains, such as coronavirus strains seen with the common cold.
    • Testing will not provide any information on a person’s immunity or risk of re-infection, but rather just that someone has been exposed.

    In addition, the following lab codes will also be covered at no cost-share to the member:

    CPT Code Description
    87631 Infectious agent detection by nucleic acid (DNA or RNA); respiratory virus (eg, adenovirus, influenza virus, coronavirus, metapneumovirus, parainfluenza virus, respiratory syncytial virus, rhinovirus), includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, multiple types or subtypes, 3-5 targets
    87635 Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (COVID-19), amplified probe technique
    U0001 Reported for coronavirus testing using the Centers for Disease Control and Prevention (CDC) 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel.
    U0002 Reported for validated non-CDC laboratory tests for SARS-CoV-2/2019-nCoV (COVID-19).
    U0003 Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (COVID-19), amplified probe technique, making use of high throughput technologies as described by CMS-2020-01-R.
    U0004 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high throughput technologies as described by CMS-2020-01-R.

     

    *Medicare MSA plan members must meet their deductible in order for the cost-share to be waived.

    Treatment

    Effective, 4/1/2020 through 5/31/2020, MVP will waive Member cost-share for the treatment of COVID-19 at any site of service, including inpatient hospitalizations and emergency room visits. Self-funded employer groups have the option to offer treatment coverage to their employees with no member cost-share.

    To ensure Member cost-share is waived for all applicable Members, use the following codes for the treatment of COVID-19:

    Diagnosis Code Description
    U07.1 COVID-19, virus identified

    In addition, in Vermont, MVP will waive member cost-share for applicable members for dates of service from 3/13/2020 through 3/31/2020 when the following code is billed:

    Diagnosis Code Description
    B97.29 Other coronavirus as the cause of diseases classified elsewhere

    For COVID-19 treatment performed 4/1/2020 or after, bill U07.1 as the primary diagnosis on the claim except:

    • For obstetrics patients as indicated in Section I.C.15.s. for COVID-19 in pregnancy, childbirth, and the puerperium.
    • For a COVID-19 infection that progresses to sepsis, see Section I.C.1.d. Sepsis, Severe Sepsis, and Septic Shock.
    • For a pneumonia case confirmed as due to COVID-19, assign codes U07.1 and J12.89 (other viral pneumonia).
    • For a patient with acute bronchitis confirmed as due to COVID-19, assign codes U07.1, and J20.8 (acute bronchitis due to other specified organisms).
    • For acute respiratory distress syndrome (ARDS) due to COVID-19, assign codes U07.1 and J80 (acute respiratory distress syndrome).

    For more information, consult the CDC Coding and Reporting Guidelines.


  • Telemedicine

    MVP is covering all telemedicine services at no cost-share to the Member during the declared State of Emergency.

    Providers should submit claims for Covered Services as outlined below in order for the Member cost-share to be waived:

    • Submit the appropriate Evaluation & Management (E/M) or CPT code (for example 99212 or 99213)
    • Submit the claim with the appropriate place of services (POS) code that would have been reported had the services been furnished in person.
    • Claim modifiers “95” or “GT” should be appended as appropriate on each claim that represents a service delivered via Telemedicine.
      • 95 modifier – Synchronous telemedicine service rendered via real-time interactive audio and video telecommunication system.
      • GT modifier – Via interactive audio and video telecommunication systems.

    Providers do not have to have an existing patient relationship with a Member to be reimbursed for telephone triage services and health care services delivered through telemedicine or audio-only telephone.

    While we encourage Providers to bill consistent with an office visit – and understand that certain services can be time consuming and complex even when provided virtually – such services should be coded at a level of care appropriate for provision through a telephonic mechanism and Providers should maintain documentation in the medical record for the level of care billed.

    Telemedicine visits will be included in any applicable Member benefit visit limitations.

    Telemedicine Platforms

    The Office for Civil Rights (OCR) at the Department of Health and Human Services (HHS) will exercise its enforcement discretion and will not impose penalties for noncompliance with the regulatory requirements under the HIPAA Rules against covered health care providers in connection with the good faith provision of telemedicine during the COVID-19 State of Emergency. Providers who want to use audio or video communication technology to provide telemedicine during the State of Emergency can use any non-public facing remote communication product that is available to communicate with patients.

    • Examples of Acceptable Platforms (non-public facing): Apple FaceTime, Google G Suite Hangouts Meet, Skype for Business
    • Examples of Unacceptable Platforms (public facing): Facebook Live, Twitch, TikTok

    Store and Forward

    In Vermont, MVP is covering Store and Forward technology when the below code, or any other appropriate procedure code, is billed, along with modifier GQ:

    CPT Code Description
    G2010 Remote evaluation of recorded video and/or images submitted by the patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment.

    Reimbursement is based on contractual agreement.


  • TeleMental Health

    Effective 3/13/2020, during the duration of the State of Emergency, Behavioral Health Providers, including qualified practitioners and services Providers, may deliver Covered Services via TeleMental Health, including telephonic services at no cost-share to the Member.

    Providers should submit the appropriate E/M or CPT code along with the POS code that would have been reported had the services been furnished in person and use claim modifiers “95” or “GT” on each claim that represents a service delivered via TeleMental Health.

    • 95 modifier – Synchronous telemedicine service rendered via real-time interactive audio and video telecommunication system.
    • GT modifier – Via interactive audio and video telecommunication systems.

    Providers in OMH/OASAS Licensed Facilities or Designated Programs should work with the NYS Office of Mental Health (OMH) to ensure the required attestation is on file with OMH. Access the Self-Attestation of Compliance to Offer TeleMental Health Services form.

    Behavioral Health Providers may bill for Applied Behavioral Analysis (ABA) Covered Services which would otherwise be covered in a Commercial Member’s Subscriber Contract for in-person visits as a TeleMental Health visit at no cost-share to the Member.


  • Telephone Visits

    Vermont Commercial Members

    As of 3/13/2020, MVP is covering telephone-only codes as a telemedicine visit at no cost-share to members in Vermont. Providers will be reimbursed same as in person visits, rates based on their Provider Agreement.

    Providers should submit claims for telephone only visits as telemedicine visits for Covered Services as outlined below in order for the Member cost-share to be waived:

    • Submit the appropriate Evaluation & Management (E/M) or CPT code (for example 99212 or 99213)
    • Submit the claim with the POS code that would have been reported had the services been furnished in person
    • Claim modifiers “95” or “GT” should be appended as appropriate on each claim that represents a service delivered via Telemedicine.
      • 95 modifier – Synchronous telemedicine service rendered via real-time interactive audio and video telecommunication system.
      • GT modifier – Via interactive audio and video telecommunication systems.

    Providers do not have to have an existing patient relationship with a Member to be reimbursed for telephone triage services and health care services delivered through telemedicine or audio-only telephone.

    While we encourage Providers to bill consistent with an office visit – and understand that certain services can be time consuming and complex even when provided virtually – such services should be coded at a level of care appropriate for provision through a telephonic mechanism and Providers should maintain documentation in the medical record for the level of care billed.

    In addition, MVP will also cover the following telephonic codes. These will be covered at no cost-share to the member during the declared State of Emergency.

    CPT Code Description
    99441 Telephone evaluation and management service; 5-10 minutes of medical discussion
    99442 Telephone evaluation and management service; 11-20 minutes of medical discussion
    99443 Telephone evaluation and management service; 21-30 minutes of medical discussion

    New York Commercial Members

    Virtual Check-In

    Providers should bill the following G codes for all Commercial members when conducting visits via telephone. These will be covered at no cost-share* to members during the declared State of Emergency.

    CPT Code Description
    G2012 Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management [E/M] services, provided to an established patient, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion
    G2010 Remote evaluation of recorded video and/or images submitted by the patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment.

    The codes below may also be used for telephonic visits with Commercial members. These will be covered at no cost-share* to the member during the declared State of Emergency.

    CPT Code Description
    99441 Telephone evaluation and management service; 5-10 minutes of medical discussion
    99442 Telephone evaluation and management service; 11-20 minutes of medical discussion
    99443 Telephone evaluation and management service; 21-30 minutes of medical discussion

    Self-funded members should consult directly with their employer to see if their employer is waiving cost-share for telemedicine or telephone visits.

    New York Medicaid Members

    The codes below should be used for telephonic visits with Medicaid members. These will be covered at no cost-share to the member during the declared State of Emergency.

    CPT Code Description
    99441 Telephone evaluation and management service; 5-10 minutes of medical discussion
    99442 Telephone evaluation and management service; 11-20 minutes of medical discussion
    99443 Telephone evaluation and management service; 21-30 minutes of medical discussion


  • Medicare Specific Information

    Effective 3/1/2020, MVP is following the payment rules published in the Medicare and Medicaid Programs; Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency, Interim Final Rule with Comment (IFC).

    COVID-19 Testing Coding

    See coding section above.

    Telemedicine for Medicare Members

    During the current State of Emergency related to COVID-19, telemedicine visits for Medicare Members will be paid at the same rate as if the visit was in person. 1. Effective 3/13/2020, telemedicine visits billed with codes 99201-99215 with the POS code that would have been reported had the services been furnished in person, and the appropriate appended modifier, “95” or “GT”, will be reimbursed at no cost-share to the Member. This applies to all services (E/M, Mental Health Counseling, and preventive services) that would have otherwise been face-to-face.

    The following modifications have been made for the duration of the declared State of Emergency:

    • Location restrictions on Originating Sites: Medicare Members can be in their home for the telemedicine visit.
    • Providers may conduct telemedicine visits with a Member that is not already established (new patients).

    Providers must use an interactive audio and video telecommunications system that permits real-time communication between the Provider (“Distant Site”) and the Member (“Originating Site”). When it is possible for Covered Services to be furnished via telemedicine, MVP will pay for such services. Such services should be coded at a level of care appropriate for provision through a telemedicine mechanism. Providers should maintain documentation in the medical record for the level of care billed. MVP may request additional documentation to review and confirm such level of care.

    The following new codes should be used for telephone visits with Medicare Members to ensure cost-share is waived:

    CPT Code Description
    98966 Telephone assessment and management service by a non-physician, 5-10 min
    98967 Telephone assessment and management service by a non-physician, 11-20 min
    98968 Telephone assessment and management service by a non-physician, 21-30 min
    99441 Telephone assessment and management service by a physician, 5-10 min
    99442 Telephone assessment and management service by a physician, 11-20 min
    99443 Telephone assessment and management service by a physician, 21-30 min
    G0071 Payment for communication technology-based services for 5 minutes or more of a virtual -non-face-to-face communication between a rural health clinic -RHC or federally qualified health center-FQHC

    More information about the Interim Final Rule can be accessed here.

    Virtual Check-In

    Consistent with CMS guidance, Providers should bill the following G codes for all Medicare Members when conducting visits via telephone. These are the only codes that may be used for Medicare Members and will be covered at no cost-share to Members during the declared State of Emergency. Claims should include the appropriate place of service code and modifiers should be appended per appropriate coding guidelines.

    CPT Code Description
    G2012 Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report E/M services, provided to an established patient, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion
    G2010 Remote evaluation of recorded video and/or images submitted by the patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment.

    Medicare E-Visits

    Medicare Part B pays for E-visits, or patient-initiated online E/M conducted via a patient portal. Providers who may independently bill Medicare for E/M visits (for instance, physicians and nurse practitioners) can bill the following codes:

    CPT Code Description
    99421 Online digital E/M service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5–10 minutes
    99422 Online digital E/M service, for an established patient, for up to 7 days cumulative time during the 7 days; 11– 20 minutes
    99423 Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutes

     

    Clinicians who may not independently bill for E/M visits (examples include but are not limited to: physical therapists, occupational therapists, speech language pathologists, clinical psychologists) may provide E-visits and bill the following codes:

    CPT Code Description
    G2061 Qualified non-physician healthcare professional online assessment and management, for an established patient, for up to seven days, cumulative time during the 7 days; 5–10 minutes
    G2062/td> Qualified non-physician healthcare professional online assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 11–20 minutes
    G2063 Qualified non-physician qualified healthcare professional assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 21 or more minutes

    Claims should include the appropriate place of service code and modifiers should be appended per appropriate coding guidelines.

    View a summary of Medicare Telemedicine Services.


  • 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 6/2/2020, Magellan and eviCore are accepting requests to obtain prior authorizations for dates of service 6/19/2020 and beyond. Pre authorization is not required for dates of service from 3/20/2020 through 6/18/2020.

    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


  • Utilization Management

    Acute Care Facilities

    All Lines of Business
    As is standard business practice, services performed in an urgent care facility or an emergency room do not require prior authorization.

    MVP is suspending the following:

    • Admission and concurrent review requirements for acute care facility admissions
    • Performing retrospective review upon receipt of a claim for an Acute Inpatient admission not previously notified

    After June 18, 2020, MVP reserves the right to retrospectively review all admissions that occurred during this 90-day timeframe regardless of notification to MVP. MVP reserves the right to retrospectively audit any inpatient claim approvals made from March 20 – June 18, 2020.

    Post-Acute Care Services

    Skilled Nursing and IP Rehabilitation Facilities
    All Lines of Business
    MVP has suspended prior authorization for transfers to Skilled Nursing and Rehabilitation Facilities. It is encouraged that Skilled Nursing and Acute Inpatient Rehabilitation Facilities continue to notify MVP (for Medicare Advantage Members continue to notify naviHealth) within 48 hours of admission.

    • MVP will waive the 3-day hospital stay rule, if it exists, for all lines of business.
    • It is preferred that members continue to be directed to participating facilities. MVP and naviHealth will not reject admissions to non-participating facilities
      • To find participating rehabilitation facilities and skilled nursing facilities, visit mvphealthcare.com/searchproviders. After you enter a zip code and choose the member’s plan type, click Search All, then type in “rehabilitation” or “skilled nursing”. You can use the filters to adjust the distance and other preferred attributes.
      • o If you need assistance navigating the Provider Search tool, or would like a list provided to you, contact the MVP Customer Care Center for Provider Services at
        1-800-684-9286.
    • If you need assistance with discharge planning, please contact your assigned MVP UM representative.
    • It is expected that transfers are medically necessary. MVP and naviHealth will perform concurrent review during member stays at skilled nursing and rehabilitation facilities. All Adverse Determination adjudication will follow all applicable NYS DFS rules for 90-day extension of timeframe for appeals.
    • Medicare Advantage Members
      • If a skilled nursing facility considers care no longer medically necessary, naviHealth should be notified prior to issuing a Notice of Medical Non-Coverage (NOMNC).

    After June 18, 2020, MVP reserves the right to retrospectively review all skilled nursing or acute inpatient rehabilitation facility admissions that occurred during this 90-day timeframe regardless of notification to MVP.

    Home Care Services
    Medicare Advantage
    MVP has suspended the prior authorization for home care services for Medicare Advantage members.

    • Home Health Agencies may continue to evaluate members home health needs without prior authorization.
    • It is encouraged that Home Health Agencies continue to provide minimal demographic information at start of care
      • Name of Agency
      • Name of Patient
      • Date of Birth
      • Member Number
      • Member Address
      • Ordering Physician Name
      • Diagnosis
      • Start of Care or Resumption of Care Date (if following a readmission)
    • If the agency determines that they need more than 10 visits, it is encouraged that you submit additional visits and supply naviHealth with the complete OASIS, 485, and last two visit notes for each discipline requested.

    After June 18, 2020, MVP reserves the right to retrospectively review all home health care that occurred during this 90-day timeframe regardless of notification to MVP.

    Commercial and Medicaid
    As always, prior authorization is not required for home health care services.

    Admission Requirements for Behavioral Health

    All Lines of Business

    MVP has modified the admission requirements for inpatient mental health, mental health residential, inpatient substance use detoxification, inpatient substance use rehabilitation, and substance use residential for 90 Days.

    Providers should notify MVP within two business days of the admission to the above levels of care. Concurrent reviews are suspended for all services mentioned above. MVP will continue to assist in coordinating care and discharge planning throughout the member’s stay.

    MVP clinicians will contact facilities for periodic consultations. These consultations are not for Utilization Review purposes, but rather for coordination of care regarding the member’s treatment and discharge plans. MVP is also offering assistance as needed during these consultations to remove any barriers there may be related to post discharge care.

    When the member is discharged, the provider should notify MVP of the discharge date along with the discharge plan within 24 hours of discharge. This includes members leaving against medical advice (AMA).

    As a reminder, Partial Hospitalization and Continued Day Treatment no longer requires prior authorization as of March 17, 2020.

    After June 18, 2020, MVP reserves the right to retrospectively review all admissions that occurred during this 90-day timeframe regardless of notification to MVP.


  • Prescriptions / Pharmacy

    MVP members are now able to obtain an early refill on a 30-day supply of maintenance medications at an in-network pharmacy, regardless of whether the state the member resides in has called a state of emergency. Medicaid members who are quarantined or whose provider suggests self-quarantine may contact CVS to request a 90-day supply of maintenance medications during the COVID crisis. MVP Medicare members may request a 90-day supply of medications at an in-network pharmacy. Members should speak with their pharmacist to enter the applicable emergency supply override code into their dispensing systems to trigger the early refill override.

    Members with a mail-order benefit taking maintenance medications should be encouraged to take advantage of the ability to receive a 90-day supply of medication through the CVS Caremark Mail Order pharmacy and mailed directly to their home. Some retail pharmacies will also mail prescriptions to a home address; members should be encouraged to please ask their pharmacist if this is an option.

    Controlled substances and specialty medications will be exempt from this override process. Please remember that most specialty medications may be obtained from the CVS Specialty Pharmacy, which mails prescriptions to a member’s home already.


  • 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.

    See the Telemedicine section for more information.


  • myERnowSM - Virtual Emergency Room

    Powered by United Concierge Medicine (UCM), myERnow is a virtual emergency room telemedicine service that allows MVP members to connect with trained emergency medicine providers, 24/7, from the comfort of their home to assess a patient’s acute medical problem including determining the need for COVID-19 testing. If testing is determined to be appropriate and available, UCM will coordinate with local health departments and health care providers and prescribe testing at an appropriate facility. If the member does not need to be tested for COVID-19, they will be given an appropriate treatment plan that adheres to current guidelines and then referred back to the appropriate provider for follow up as needed.

    UCM is integrated with regional health information organizations (RHIO), which allows them to share information with the members’ primary care physician (PCP). UCM is dedicated to triaging patients via telemedicine, then helping to direct members to the right site of service. Their aim is to partner with MVP’s participating providers to provide the right care for our members, in the right place, and at the right time.

    Learn more about myERnow. Learn more about UCM.

    myVisitNow is a great option for MVP members who are at low risk for COVID-19 but need care. myVisitNow includes urgent care, psychiatry, qualified mental health, nutrition counseling, and lactation services. Providers who don’t offer their own telemedicine services are welcome to refer MVP members to use myVisitNow.


  • 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.


  • Additional Resources