Medical Business Advisory / New CPT Code 99072 Usage and Coverage

New CPT Code 99072 Usage and Coverage

Early this month, the American Medical Association (AMA) published an update to the Current Procedural Terminology (CPT­­­) code set.  The update includes the additional code “99072” as a response to measures adopted by medical practices and health care organizations to help prevent the spread of COVID-19, while continuing to provide high quality, in-person care to patients safely. The description for code 99072 is as follows: “Additional supplies, materials, and clinical staff time over and above those usually included in an office visit or other non-facility service(s), when performed during a Public Health Emergency as defined by law, due to respiratory-transmitted infectious disease.  Use 99072 only when safety measures are over and above those usually included during an office visit or service.”

Although initiated and approved by the AMA, the Centers for Medicare and Medicaid Services (CMS) has yet to add the code to its fee schedule. We believe it is doubtful that this code will be covered by Federal, State or Commercial payers unless the PHE is extended into 2021.  Until Medicare, Medicaid and Commercial Payers have made an official decision regarding covering code 99072 (if at all), we are advising practices interested in trying to bill for this CPT code, to consider running a test with each insurance company before implementing the code across all payers. In addition, the test will allow you to make sure all of your claims for each payer are not denied for an unrecognized CPT code on a claim. Closely monitor this code for insurance denials and make a decision as to how you will handle those denials when billing patients.  For pricing, we suggest you calculate your costs for this extra work and price 99072 accordingly.

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