Update on CPT Code 99072

As many clinicians are now aware, The American Medical Association (AMA) published a new Current Procedural Terminology (CPT®) code on September 8, 2020 that accounts for extra provisions to ensure patient and provider safety during a public health emergency. 

At that time, they announced that the code is effective immediately: CPT 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.

Per the AMA, providers can bill 99072 “with an in-person patient encounter for an office visit or other non-facility service, in which the implemented guidelines related to mitigating the transmission of the respiratory disease for which the PHE was declared are required.”

Put simply, that means providers can bill this code: 

  • during an official public health emergency
  • when they see a patient in-person

As per the AMA CPT code 99072 was approved in response to sweeping measures adopted by medical practices and health care organizations to stem the spread of the novel coronavirus (SARS-CoV-2), while safely providing patients with access to high-quality care during in-person interactions with health care professionals. The additional supplies and clinical staff time to perform safety protocols described by code 99072 allow for the provision of evaluation, treatment or procedural services during a public health emergency in a setting where extra precautions are taken to ensure the safety of patients as well as health care professionals. The AMA/Specialty Society RVS Update Committee (RUC) worked with 50 national medical specialty societies and other organizations over the summer to collect data on the costs of maintaining safe medical offices during the public health emergency and submitted recommendations today to the Centers for Medicare and Medicaid Services to inform payment of code 99072.

In everyday clinic life this is to cover the extra time and materials required to perform tasks such as :

  • screening patients
  • don and doff PPE
  • cleaning and sanitizing treatment areas and equipment

Billing this code is relatively straightforward. At this time it does not seem to require any modifiers, and it can be billed with any diagnosis code. It is an untimed unit, and providers can bill it “once per in-person encounter”.

On October 27, 2020 CMS announced it has assigned CPT 99072 procedure status “B.” By this they mean:

  • there are no RVUs for this code 
  • CMS considers it to be bundled with whatever service was provided that day
  • CMS’ contractors will not pay for this service
  • providers may not bill the beneficiary for this service 
  • issuing an Advanced Beneficiary Notice related to this service is not an option

At this time it means that some third-party payers may reimburse providers for this new CPT code while others won’t.

If the commercial payer declines to pay for 99072, clinicians may wonder if they are to charge patients cash for this codeAccording to the APTA, some state laws “restrict the application of surcharges for additional supply expenses associated with the public health emergency.” In other words, you can’t charge patients for this code.

We recently had challenges with this code in our clinic. Unfortunately when we added it to the claim it resulted in denial of the entire claim. We had to go back over each claim and remove the code, then resubmit them. 

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