AMA Releases New CPT® Code for PPE Costs During COVID-19
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On September 8, 2020, the American Medical Association® (AMA) added a new CPT® code, 99072, for reporting the use of the additional cost of personal protective equipment (PPE) supplies, materials, and time to safely care for patients during a COVID-19 Public Health Emergency (PHE).
Not sure what 99072 is and how to bill for additional PPE costs? Here are a few dos and don’ts for billing this new CPT code.
What is the Definition for CPT® Code 99072?
The AMA defines the 99072 CPT® code as “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.”
What Practice Expenses Does CPT® 99072 Include?
According to the AMA CPT® Assistant (Special Edition September Update), the new 99072 code includes the following practice expenses:
Performing pre-visit phone calls to screen the patient (symptom checks), providing social distancing instructions during the visit, checking patients for symptoms when they arrive at your office (taking temperatures and asking questions), putting on and taking off PPE, and cleaning and sanitizing rooms.
Three surgical masks
Cleaning supplies (hand sanitizer, disinfecting wipes, sprays, and cleansers)
What Are CPT® 99072 Dos and Don’ts?
The AMA recommends not to use CPT® 99070 to report the extra cost of PPE supplies during the Public Health Emergency (PHE) and to use code 99072 instead, as this new code better reflects the additional costs associated with PPE supplies during COVID-19. Once the PHE has ended, do not use code 99072 as the code will be invalid.
You should only report code 99072 once per in-person patient encounter/per provider identification number (PIN), regardless of the number of services you provide during the patient encounter.
The patient doesn’t need a COVID-19 test or diagnosis to report code 99072.
Do not report 99072 for nursing facility visits as those are considered facility services.
Not every insurance payer is covering additional PPE costs and accepting 99072 on the claim. For example, the Centers for Medicare & Medicaid Services (CMS) and the Federal Employee Program (FEP) have not announced reimbursement policies for Medicare Advantage of FEP members. Before you bill for 99072, verify with your third-party insurance payers and state laws regarding charging patients for PPE costs.
Pro Tip: Check out the AMA CPT® COVID-19 coding and guidance website to stay up-to-date on SARS-CoV-2 related CPT® codes.
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