Capture COVID Practice Expense Factors with CPT Code 99072

Billing Requirements for CPT Code 99072

What is code 99072 and how do we use it? What documentation is necessary for reimbursement of this new CPT code?  Let us review the rules for this code and see if your practice can bill for it.

The Definition

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.

Background of Code 99072

The 2020 Public Health Emergency resulted in sudden and drastic societal change to stem the transmission of SARS-CoV-2.  Patients were encouraged to postpone elective medical procedures, or to utilize telemedicine when possible for their healthcare needs.  However, physicians must see patients in person for certain conditions and the AMA recognizes that significant additional practice expenses are incurred related to the supplies and activities required to safely provide medical services during the PHE.

In September 2020, CPT code 99072 was approved in response to sweeping measures adopted by medical practices and healthcare organizations to stem the spread of the novel coronavirus (SARS-CoV-2), while safely providing patients access to high-quality care during in-person interactions with health care professionals. Code 99072 describes the additional supplies and clinical staff time required to mitigate transmission of respiratory infectious disease while providing evaluation, treatment, or procedural services during a public health emergency. Not only are these extra precautions necessary for the safe care of the patients, they are also necessary to protect the healthcare professionals providing services to those patients.

What expenses are covered?

The AMA guidelines help to clarify what is covered. CPT code 99072 is designed to capture practice expense factors such as the following:

• Time over what is included in the primary service of clinical staff time (registered nurse (RN) / licensed practical nurse (LPN) / medical technical assistant (MTA) to conduct a pre-visit phone call to screen the patient (symptom check), provide instructions on social distancing during the visit, check patients for symptoms upon arrival, apply and remove PPE, and perform additional cleaning of the examination / procedure / imaging rooms, equipment, and supplies.
• Three surgical masks.
• Cleaning supplies, including additional quantities of hand sanitizer and disinfecting wipes, sprays, and cleansers.

Activities and supplies must be over-and-above the protocols in place for a typical patient encounter or standard operational procedures that are in place outside of the PHE.

When to bill for code 99072 and how to document the encounter properly

Please be sure to check with your local MAC contractor, as well as commercial and third-party payers, to be sure you understand the documentation requirements for the codes, what to charge for the code and whether the payers will reimburse for the code. For example, BCBS of North Carolina has posted the following information regarding reimbursement:

For Blue Cross NC commercial members (fully insured, State Health Plan, Inter-Plan Program Host members), providers can include code 99072 on the claim; however, payment will be considered “incident to” the course of diagnosis or treatment of a condition (i.e. furnished as an integral, although incidental, part of the physician’s personal professional services). As such, it will not be paid separately.

Medicare also considers 99072 a bundled code and is not reimbursing for it separately. Obtain advice from your attorney or a healthcare consultant before deciding to bill for this code.  

You may report code 99072 only once per in-person patient encounter per day regardless of the number of services rendered at that encounter. Code 99072 may be reported during a PHE when the additional clinical staff duties as described are performed by the physician or other qualified health care professional in lieu of clinical staff.  Time spent on the activities described by this code may not be counted toward other time-based service during that encounter.

Only use this code in a non-facility place of service (POS) setting, and in an area where it is required to mitigate the transmission of the respiratory disease for which the PHE was declared. Use of this code is not dependent on a specific patient diagnosis.

When the PHE is over, this code will be inactive. 

Clinical Example (CPT Assistant)

A 65-year-old female presents to the physician’s office, requiring care for an illness, acute injury, or ongoing care for a chronic condition. The encounter occurs during a PHE, as defined by law, due to respiratory-transmitted infectious disease.

For up-to-date training and information, AIHC offers an on-demand short course, COVID-19 Coding and Billing Encounters.