CurrentMVP Health CarePolicy N/A

In-Office Procedure List (CPT/HCPCS) Coverage

This document lists procedures that MVP limits to the physician's office place of service and describes prior authorization requirements for claims submitted with a different place of service. It affects providers submitting claims to MVP Health Care for the listed CPT/HCPCS codes.

Policy Summary

PayerMVP Health Care

PolicyIn-Office Procedure List (CPT/HCPCS) Coverage

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateJun 1, 2021

Next Review DateN/A

Key ActionObtain prior authorization for any listed procedure performed outside the physician's office to avoid claim denial.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

multiple hundredsprocedure codes listed (CPT/HCPCS)

06-01-2021effective date stated in document

physician's office onlyplace of service restriction

CMSsource of the list

In-Office Coverage Limitations

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Sample Codes and Place of Service

Covered CPT Codes (sample)CPTCovered

10040	Listed as in-office eligible code (paired entries present)
10080	Listed as in-office eligible code (paired entries present)
10120	Listed as in-office eligible code (paired entries present)

Place of service restriction

RestrictionCoverage limited to physician's office

Consequence for other POSClaims with a place of service other than the physician's office will be denied unless prior authorization is obtained

Additional PA noteThere may be additional prior authorization requirements for the procedure; consult MVP's Prior Authorization list

Prior Authorization and Billing Actions

Prior Authorization

Prior authorization required for non-office place of service

Claims submitted with a place of service other than the physician's office must have prior authorization; otherwise they will be denied. Verify and obtain any additional prior authorization(s) required for the specific procedure per MVP's Prior Authorization list before submitting the claim.

Obtain prior authorization before submitting claims for services performed outside the physician's office.
Check MVP's Prior Authorization list for any additional procedure-specific authorization requirements to avoid denial.

Key Definitions

physician's office (place of service)

Termphysician's office

ContextProcedures on this list are covered only when performed in the physician's office place of service

Effective dateEffective 06-01-2021

Prior authorization (non-office place of service)

DefinitionPrior authorization is required for claims submitted with a place of service other than the physician's office

Denial riskSuch claims will be denied unless prior authorization is obtained

Further requirementsThere may be additional prior authorization requirements for the procedure; see MVP's Prior Authorization list