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New CPT® Code for COVID-19 Expenses

By Elizabeth Woodcock, MBA, FACMPE, CPC

September


On September 8, the American Medical Association announced the addition of CPT® 99072 with the express purpose to account for the supplies and clinical staff time required for medical practices to mitigate COVID-19 transmission. Acknowledging the practice expenses related to patient safety during the pandemic, the AMA states that the code represents “supplies, materials, and clinical staff time required for patient symptom checks over the phone and upon arrival, donning and removing personal protective equipment (PPE), and increased sanitation measures to prevent the spread of communicable disease.” The AMA also outlines the code’s coverage of providing instructions on social distancing; surgical masks; and cleaning supplies. 99072 is to be reported once per face-to-face encounter during the Public Health Emergency (which ends October 23); it is only for use in non-facility settings such as physicians’ offices. The use of the code is not dependent on the patient’s diagnosis.

99072 is effective for use immediately, however, getting paid is the tricky issue. The code was announced prior to the establishment of the code’s value, so there was immediate confusion about the amount to charge for 99072. More importantly, the AMA makes it clear that reimbursement (as well as other requirements such as documentation) is up to each payer. Watch for news regarding payment for this new code – and advocate for its coverage.                      

CPT® Description

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.”

For more information about 99072, see https://www.ama-assn.org/system/files/2020-09/cpt-assistant-guide-coronavirus-september-2020.pdf.

For more information about the Public Health Emergency Declaration, which was last renewed on July 23, see https://www.phe.gov/emergency/news/healthactions/phe/Pages/default.aspx.

About The Author

Elizabeth Woodcock is the founder and principal of Woodcock & Associates. She has focused on medical practice operations and revenue cycle management for more than 25 years. She has led educational sessions for a multitude of national professional associations and specialty societies, and consulted for clients as diverse as a solo orthopaedic surgeon in rural Georgia to the Mayo Clinic. She is author or co-author of 17 best-selling practice management books, to include Mastering Patient Flow and The Physician Billing Process: Avoiding Potholes in the Road to Getting Paid. Elizabeth is a Fellow in the American College of Medical Practice Executives and a Certified Professional Coder. In addition to a Bachelor of Arts from Duke University, she completed a Master of Business Administration in healthcare management from The Wharton School of Business of the University of Pennsylvania. She is currently a doctoral student at the Bloomberg School of Public Health of Johns Hopkins University.

The contents of The Sentinel are intended for educational/informational purposes only and do not constitute legal advice. Policyholders are urged to consult with their personal attorney for legal advice, as specific legal requirements may vary from state to state and/or change over time.

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