In September of the current year, the American Medical Association announced two new codes which would be added to the Current Procedural Terminology (CPT) codeset, which are needed in response to the COVID-19 pandemic sweeping the globe and this country in particular. These two codes have been approved for immediate use, so that tools and services used to combat the pandemic can accurately be reported on medical claims, and so healthcare providers can be reimbursed for those services.

CPT Code 99072

This code became necessary so that high-quality medical care could be delivered to patients even while the coronavirus continued to sweep the nation, infecting more and more patients every day. Much of the care which must be provided to COVID-19 patients must be in-person care, and that of course puts healthcare personnel at greater risk themselves. This code covers the need for providing extra care to infected patients which requires greater hygiene for both patient and caretaker, including all the required safety protocols and precautions.

The AMA developed this code as a result of close collaboration with a number of healthcare agencies and providers, so that the public health emergency could be dealt with in the safest possible manner. The 99072 code will be used whenever it is necessary to provide materials, supplies, and clinical staff time over and above what would ordinarily be required for patient safety. Specifically, 99072 will cover actions and materials needed during an officially declared Public Health Emergency, which is attributable to a respiratory-transmitted disease that has proven to be infectious. 

What the new code means 

Highlights Of the New CPT Code 99072

This new code is intended to cover the cost of using equipment and materials necessary for sanitary and safe treatment of patients during the coronavirus pandemic, including the time it takes for staff members to don and discard Personal Protective Equipment necessary for treating infected patients. It will also cover any extra time needed to screen patients for potential symptoms related to the disease, any additional sanitation or cleaning processes which may be required, and all extra steps necessary to safely treat infected patients.

The AMA has been made aware of all the extra costs which have been associated with treating COVID-19 patients, and those extra costs cannot be absorbed by healthcare providers, so they must be incorporated into the actual costs of patient care. One important stipulation associated with this new code, is that it does not cover such costs when they are provided by a full-blown healthcare facility such as a hospital. The wording in the writeup for the new code specifically states that it is intended to cover costs during office visits, or during other non-facility visits.

Examples provided in the writeup for the new 99072 code specifically reference the extra clinical staff time required to screen patients prior to in-person visits, the instructions which must be provided during an in-person visit with regard to social distancing and mask wearing, the process of checking any patient for symptoms such as fever at the office, the time necessary for putting on and taking off any PPE, and all extra cleaning and sanitation processes which the office personnel are obliged to perform.

Will the new code be paid? 

As with any new medical billing code, there’s always some uncertainty surrounding the reimbursement for services covered under the new code. This new billing code 99072 will be no exception. Yes, it has been announced by the AMA, so it certainly has official backing and there’s no question about its legitimacy. However, being a brand new code, it will undoubtedly not be included among older codesets, possibly including the one used by your insurance carrier.

In practical terms, it is quite likely to be denied or considered invalid, at least for the present time. That means it will be possible that any immediate usage of code 99072 could result in denials of the line item, at least until the payers update their systems and contracts. Some patience will be necessary as the code becomes more widely accepted and recognized, and at that time the reimbursements will begin to be paid as they should be, with denials gradually diminishing.

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