10/19/2020

CPT 99072

Should we start billing for CPT Code 99072? I've heard from other colleagues that they have been rejected and have to resubmit the claim without the code?

Announced earlier this week by AMA, CPT code 99072 is a new practice expense code that describes the additional supplies and clinical staff time providers are using to stop the spread of the novel coronavirus while still providing safe in-person visits.

The code should only be used during a declared public health emergency and is different from code 99070, which is typically reported for supplies and materials that may be provided to patients during a normal office visit.

CPT code 99072 should be reported only once per in-person visits per provider identification number (PIN), regardless of the number of services performed during the visit.

AMA also noted that it has submitted recommendations to CMS to “inform payment” of the new CPT code.

Additionally, the latest CPT code set announcement from the AMA included the unveiling of the new CPT code 86413 for the reporting of quantitative measurements of COVID-19 antibodies.

What Insurers Are Covering the 99072 and 86413?

 Documentation requirements for 99072 and 86413 will vary among insurers, so be sure to check with your top payers for their specific policy. 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 claim denials, it’s always wise to confirm with your payers if they are accepting 99072 yet, and if not, when you can expect it.