Guidance for Providers Treating MVP Health Care Members
MVP has extended the Member cost-share waiver for COVID-19 treatment costs for any site of service, including inpatient hospitalizations and emergency room visits, for New York fully insured health plans and Medicare health plans through July 31, 2021. Medicare MSA Members must first meet their deductible to achieve $0 cost-share. The Member cost-share waiver for Vermont fully insured health plans has been extended through March 1, 2022. Self-funded employer groups have the option to waive COVID-19 treatment costs for their plan participants.
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
To ensure Member cost-share is waived for applicable Members as described above, use the following codes for the treatment of COVID-19:
|U07.1||2019-nCoV acute respiratory disease|
|J12.82||Pneumonia due to coronavirus disease 2019|
|M35.81||Multisystem inflammatory syndrome|
|M35.89||Other specified systemic involvement of connective tissue|
For COVID-19 treatment performed April 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.
Monoclonal Antibodies COVID-19 Billing Guidance
The FDA has issued Emergency Use Authorization (EUA) for the following investigational monoclonal antibody treatment for COVID-19:
- Casirivimab and imdevimab
- Bamlanivimab and etesevimab
The EUA allows any of these three treatments to be administered to non-hospitalized adults and pediatric patients (12 years of age and older weighing at least 40kg) with confirmed COVID-19 infection, who are experiencing mild to moderate symptoms, and are at high risk for progressing to severe symptoms and hospitalization. For purposes of the EUA Casirivimab and imdevimab must be administered together by intravenous (IV) infusion.
Allocation and distribution of the treatments are determined by the U.S. Department of Health and Human Services, Office of the Assistant Secretary of Preparedness and Response (HHS/ASPR).
MVP will reimburse for the administration of the treatments listed above at no cost share to MVP Medicaid Managed Care and commercial Members when the codes below are submitted. MVP will not provide payment for the monoclonal antibody products that health care providers receive for free, as will be the case upon the product’s initial availability in response to the COVID-19 public health emergency.
- M0239 (intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring)
- M0243 (intravenous infusion, casirivimab and imdevimab, includes infusion and post administration monitoring)
- M0245 (intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring
Providers should bill Medicare Fee-for-Service (FFS) directly for the monoclonal antibody products and administration of these products to MVP Members enrolled in Medicare Advantage. Reimbursement submitted to MVP for these Members will be denied.