New CPT Code 99072 Review

Oct 23, 2020 | ANJC News & Updates, Covid-19, Industry News, Insurance News

In September, the AMA released a new CPT code, 99072, created to address additional expenses incurred by providers as a result of additional safety measures and cleaning supplies needed due to the COVID-19 pandemic.

The formal definition of CPT 99072 is Additional supplies, material, 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 (PHE) as defined by law, due to respiratory-transmitted infectious disease.

Documentation of 99072:  The AMA did not include any specifications regarding how to document this code.  In their CPT Assistant article they refer to the definition of the code and note that “documentation requirements may vary among third-party payers and insurers; therefore, they should be contacted to determine their specifications.”  As we have not seen any guidance from carriers’ operating in NJ thus far, we recommend the following as a minimum of documentation for this service if billed:

  • Document the supplies used above what would normally be used – gloves, masks, wipes, etc.
  • Document any materials used above what would normally be used – air flow systems, plastic guards, etc.
  • Document clinical staff time over and above what is usually included – cleaning time, prep time, patient wait arrangements, e.g. calls to patients in the car, etc.

Pricing of 99072:  At this time there is no Medicare fee schedule amount for this code.  Fair Health, a nationally recognized usual and customary database, also has no pricing data on this code as of yet.  As such, we recommend that when setting a fee for this service for your office that you correlate the charge to the actual additional expenses that your practice has incurred in a reasonable way. 
For instance, you could determine from your expenditures how much more you spend on cleaning and sanitary supplies such as cleaning spray, paper towels, hand sanitizers, wipes, masks, etc. than you did prior to the pandemic in a given month.  You could then divide this amount by the average number of patient visits per month and use that as a basis for your charge.  You could also make similar calculations based on additional staff time needed to review the new protocols with patients, perform temperature checks, ask COVID related questions and/or file forms with such questions that patients fill out as well as larger expenditures such as new or updated air filtration systems, new plexiglass or other barriers, etc. 

Additional coding guidelines for 99072:

  • The time counted in any other time-based visit or service during the same encounter cannot be counted twice to report this code.
  • You may report 99072 only once per in-person patient encounter per Provider Identification Number (PIN).
  • You do not need to link the code to a particular diagnosis code such as ICD-10-CM U07.1 COVID-19.
  • You may report 99072 with an evaluation and management (E/M) service or procedure even if it is not PHE-related. (although a PHE must be declared in effect at the time of service)

For more detailed information regarding this new code please see the AMA-CPT Assistant’s September Special Edition Update:


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