Your cry that COVID-19 is costing you time and money has been heard. Now, you could be compensated for the extra expense that your practice spends on creating a safe environment for your patients and staff.
Recently, the AMA created new CPT code 99072 to reimburse you under these circumstances. Below, find out exactly how to protect your practice’s bottom line from COVID by correctly using new CPT code 99072.
What Does 99072 Pay for?
Early in September, the AMA approved new CPT code 99072, to compensate you for the additional supplies, materials, and clinical staff time you spend on the following COVID-related activities:
- Performing patient symptom checks over the phone and upon arrival (i.e. taking temperatures, asking questions, and providing distancing instructions)
- Putting on and removing personal protective equipment (PPE)
- Increased sanitation measures to prevent COVID spread, including cleaning supplies like hand sanitizer, disinfecting wipes, and more.
Here’s the long descriptor for 99072:
“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.”
“Additional” means over and above what you usually include in a patient visit or service to ensure a safe in person visit and reduce the risk of the communicable disease for which the Public Health Emergency (PHE) was declared. For example, if your providers do not typically wear masks during patient visits, and now, due to the pandemic, they do, that meets the definition of “additional.”
Tip: 99702 includes up to three surgical masks per encounter per encounter per provider.
Is a COVID Diagnosis Needed to Report 99072?
Because this code is related to actions you take to reduce the risk of COVID transmission, the patient does not need a COVID diagnosis — or test — to report code 99072.
How Is the New Supply Code Different From 99070?
If the description of 99072 sounds familiar, you’re right. It probably reminds you of CPT code 99070 — a code used to account for supplies and materials that are used or provided to a patient during an office visit or for a service provided in the office. But there are a few significant differences between 99070 and 99072 that you must know:
- You can report code 99070 at any time, for any encounter that meets the requirements. In contrast, you may only report code 99072 during a declared Public Health Emergency, and only in relation to the respiratory-transmitted infections disease for which the PHE was declared.
- 99070 is intended for supplies you use beyond what’s usually included in a particular service (i.e. trays, IVs, or other medical supplies). 99072 is only intended for supplies beyond what you’d use to provide a safe, in-office environment for patients.
- 99070 doesn’t include staff time — 99072
Important: You can report 99070 and 99072 for the same encounter, as long as you meet the requirements for both codes.
Is 99072 Allowed for My Doctor?
New CPT code 99072 isn’t specialty-specific — any specialty can use the code as long as the patient encounter meets the code’s requirements. But you can only report 99072 for services provided in an office or other non-facility setting.
Remember that 99072 is used per encounter, not per service. You may report 99072 only once per encounter per provider PIN, no matter how many services are performed during the encounter.
And beware of double dipping. If you count clinical staff time towards 99072, you cannot include that time towards another time-based visit or service reported during the same encounter. Plus, you may only include the time element when it’s your clinical staff that performs the tasks. This includes RNs, LPNs, MTAs, and so on, or physicians in lieu of clinical staff).
What Insurers Are Covering the PPE Supply Code?
Documentation requirements for 99072 will vary among insurers, so be sure to check with your top payers for their specific policy. One thing that’s certain: Your documentation must include information that supports the requirements for 99072. Include a statement that notes “Due to COVID-19 …” and then document what steps you took or supplies you used.
Since this code is so new, it’s tough to predict its prospects for payment. First, you’ll have to manually upload the new CPT code to your system — and it may take payers some time to update their own systems and policies. To avoid claims denials, it’s always smart to confirm with your payers if they are accepting 99072 yet, and if not, when you can expect it.
COVID-19 Related Online Training Resources
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