MSSNY in Action: Expanding Nebulizer Treatment Coverage for NYS Medicaid Patients
MSSNY was recently made aware by Lisa Chinnici from Panoram Pediatric office that NYS Medicaid would only cover one in-office nebulizer treatment per month. If multiple CPT codes were billed within a month, the patient would be denied coverage, resulting in a loss of revenue for the practice. After being informed of this issue, MSSNY’s Physician Payment and Practice division brought it to the attention of the NYRxEO team, who quickly began looking into it with the Department of Health (DOH). DOH agreed to consider the issue and requested data from MSSNY to inform their decision. MSSNY provided the necessary information, which led to DOH expanding its coverage to include more than one in-office treatment, effective April 1, 2024. This outcome would not have been possible without the hard work and dedication of Heather Lopez, VP of Payment & Practice Division, MSSNY members, and the assistance of the NYRxEO team.
