AMA Approves 2 New CPT Codes for COVID-19

AMA Approves 2 New CPT Codes for COVID-19

One of the codes, 99072, is for reporting additional supplies used to mitigate spread of the virus.

The American Medical Association (AMA) announced, Sept. 8, two new Category I CPT® codes to meet the changing needs of the healthcare industry brought about by the COVID-19 public health emergency (PHE). The codes were approved by the CPT® Editorial Panel for immediate use during the PHE for COVID-19.

“The CPT code set continues to quickly adapt during the COVID-19 pandemic to streamline the reporting of innovative tools and services now available to help reduce the COVID-19 disease burden, improve health outcomes and reduce long-term care costs,” said AMA President Susan R. Bailey, M.D. “This update is the latest in a series of modifications to the CPT codes set to meet the needs of the health care industry as medical advancements expand the fight against COVID-19.”

New Special Services, Procedures, and Reports Code

99072Additional 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

CPT® code 99072 encompasses the additional supplies, materials, and clinical staff time required to support safe in-person patient interactions with healthcare professionals during the PHE for COVID-19.

As explained in a Sept. 8 CPT® Assistant Special Edition, use 99072 only when safety measures are over and above those usually included during an office visit or service (as opposed to CPT® code 99070, which covers supplies, materials, and time used during a typical office visit).

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 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.
  • You may report 99072 only once per in-person patient encounter per Provider Identification Number (PIN).

New Pathology and Laboratory Code

86413Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) antibody, quantitative

CPT® code 86413 was approved in response to the development of laboratory tests that provide quantitative measurements of SARS-CoV-2 antibodies, as opposed to a qualitative assessment (positive/negative) of SAR-CoV-2 antibodies provided by laboratory tests reported by other CPT® codes.

By measuring antibodies to the virus, the tests reported by 86413 can investigate a person’s adaptive immune response to the virus and help access the effectiveness of treatments used against the coronavirus.

Standard Protocol

Per the standard early release delivery process for CPT® codes, you will need to manually upload the code descriptors into your electronic health record (EHR) system. These CPT® codes will most likely arrive as part of the complete CPT® code set in the data file for 2021 later this year; however, due to the fluid nature of the novel coronavirus, it is important to stay abreast of updates from the AMA as they are released. Always check with your payer for coverage of new codes.

UPDATE: CMS rescinded Transmittal 10331, dated Aug. 28, 2020, and replaced it with Transmittal 10373, dated, Sept. 24, 2020, to add new section I.B.2. “New Category I CPT code 99072 for Reporting of Additional Practice Expenses Incurred During a Public Health Emergency (PHE), Including Supplies and Additional Clinical Staff Time.” They also added CPT code 86413 to table 1, attachment A and added new table 2, with the new 99072 CPT code.

Per MLN Matters 11937, 86413 is contractor-priced (where applicable) until it is nationally priced and undergoes the CLFS annual payment determination process.

MLN Matters MM11939 Revised, issued Oct. 27, assigns procedure status indicators for these codes.

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37 Responses to “AMA Approves 2 New CPT Codes for COVID-19”

  1. BECKY HUTCHENS says:

    DO WE NEED TO ADD A CHARGE TO 99072?

  2. Jennifer McCosh says:

    Is there any policies from insurance payers whether or not this CPT will be reimbursable? What about a fee schedule recommendation?

  3. Lee Fifield says:

    Jennifer, CMS and other payers have not yet indicated whether they will cover these new codes.

  4. Ashley Massey says:

    Is this code effective now or for 2021?

  5. Leta Dineen CPC says:

    is there any indication that this will need to be billed with a modifier? and if so which one for what circumstance? for example we are holding an outside flu clinic that will require additional ppe and clinical time. We would normally just bill the admin and the vaccine. Thanks

  6. Lee Fifield says:

    Ashley, these codes are effective for immediate use during COVID-19.

  7. Renee Dustman says:

    No, AMA would not be the authority to require a modifier. You will need to check with each payer.

  8. Josey Raezler says:

    Would this include a mask given to a patient that doesn’t have one? or just staff?

  9. Wanda Wilson says:

    Is this code retro to the beginning?

  10. Lee Fifield says:

    CMS has not released any guidance about reimbursement or reporting at this time. Contact your third-party payers to confirm reimbursement, policies, and reporting guidelines.

  11. Deborah Ellis says:

    Is there any guidance on how we calculate what we would charge for the 99072?

  12. lori walston says:

    what is expected reimbursement by Medicare?

  13. Renee Dustman says:

    CMS just released this:
    Transmittal 10331, dated August 28, 2020, is being rescinded and replaced by Transmittal 10373,
    dated, September 24, 2020 to add new section I.B.2. “New Category I CPT code 99072 for Reporting of
    Additional Practice Expenses Incurred During a Public Health Emergency (PHE), Including Supplies
    and Additional Clinical Staff Time”. We also added a new COVID-19 CPT code, 86413, to table 1,
    attachment A and added new table 2, with the new 99072 CPT code. https://www.cms.gov/files/document/r10373cp.pdf

  14. Donna Clemons says:

    Appropriate modifier for 99072 when billing Tricare?

  15. Samantha Parkhurst says:

    What is the charge? Are the 50th, 75th & 90th percentile values updated / where would we find the charges?

  16. Jane OConnell says:

    Is there an average cost to the patient?

  17. Erin Homer says:

    Does 99072 get a modifier? Some insurances are bundling it so I wasn’t sure if maybe their system isn’t updated or if it needs a modifier.

  18. MARA says:

    good afternoon i need help i work at an urgent care and this his how my provider want me to bill for covid 19 test
    99213 cs Z20.828
    99072
    87426

  19. Renee Dustman says:

    We can’t say for sure, not knowing the circumstances. Just make sure documentation supports billing 99072.

    99072 Additional supplies, materials, and clinical staff time over and above those usually included in an office visit or other nonfacility service(s), when performed during a Public Health Emergency, as defined by law, due to respiratory-transmitted infectious disease
    As explained in a Sept. 8 CPT® Assistant Special Edition, use 99072 only when safety measures are over and above those usually included during an office visit or service (as opposed to CPT® code 99070, which covers supplies, materials, and time used during a typical office visit).
    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 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.
    • You may report 99072 only once per in-person patient encounter per Provider Identification Number (PIN).

  20. Heather M, CPC, CPB says:

    FCSO, FL MAC, will not accept CPT 99072 and representatives have stated that FCSO considers “99072 a bundled” service and 0, zero, RVU’s have been assigned. Based on the CPT code definition, and legitimate costs incurred, our provider(s) disagree with this decision.

  21. Jamie Kitson says:

    I am researching information regarding 99072. I have printed some documentation from the Medicare website, has anyone been reimbursed yet? I have called several insurance companies, but we are still seeing rejections.
    Please email me at Jamie@stoddenpt.com with your suggestions.

    Thank you.

    Jamie

  22. Nora Lopez says:

    I am billing an E&M code with modifier 25 and 99072 for the extra PPE used during the Evaluation and Treatment of a suspected Covid-19 patient.
    I have not received payment from any insurance. Is there a reason why these insurance companies are not recognizing this new code.??
    Does anyone have any answers or suggestions??
    Appreciate it.
    Thanks
    Curious Nora

  23. Angie Kowis says:

    99072 is being denied by all Aetna, BCBS, Cigna, Devoted, Texan Plus, UMR, United Healthcare, as being Incidental. If we put it on a claim for Medicare it gets denied in our Clearing House. So no one is paying for this code as of yet.

  24. Renee Dustman says:

    No, and Medicare doesn’t plan to.

  25. Renee Dustman says:

    Medicare isn’t paying 99072

  26. Michelle Barton says:

    I have yet been able to get the code paid using 99072.

    99213
    99072

    How are you billing? What are you charging? Do you use a modifier?

  27. Kim Chemo says:

    Not any of the insurances are paying for this code. Has anyone had a different experience? All indicate it is bundled.

  28. Rebecca Haines says:

    Does anyone have a fee established for 87426? How did you calculate if so?

  29. Melanie Edwards says:

    CMS shows an OPPS status indicator of B for 99072, meaning it is bundled. What modifier should be used then to unbundle and receive this additional payment?

  30. Tracy Mann says:

    If no one is paying for it, why are we billing it? It seems like extra time and work on our part for no apparent reason. Please advise.
    Thank you.

  31. Renee Dustman says:

    Medicare won’t pay for 99072; there are no RVUs assigned to this code.

  32. Dominique says:

    Can you bill cpt 99072 for DOS before 9/18/20?

  33. Tammy Vires says:

    What is the deadline for billing code 99072? Is any Insurance company paying for this still?

  34. Wendy M says:

    cigna is not paying incidental/unbundled to another procedure. Has anyone got paid? Are you using a modifier?

  35. R. Bassi says:

    I have spoken to UHC they denied cpt 99072 as inclusive, but said send correct claim with a modifier to unbundle the procedure. Does anyone know
    what that modifier is?

  36. Renee Dustman says:

    I think someone gave you misinformation. According to this UHC guidance, they will not pay 99072 with or without a modifier.

    https://www.uhcprovider.com/content/dam/provider/docs/public/policies/oxford/b-bundle-codes-ces-ohp.pdf

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