Question Billing for Personal Protective Equipment (PPE)

SharonCollachi

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There is a HCPCS code, but only for very specific circumstances, such as End Stage Renal Disease, and then it is only available under Medicare Part A and not Part B (most people with ESRD have Medicare).

You could always sell them to the patients for cash at cost. But the bigger question in my mind is, who has enough to be giving them to patients??? We don't even have enough for our medical staff.
 

cappy

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There is a HCPCS code, but only for very specific circumstances, such as End Stage Renal Disease, and then it is only available under Medicare Part A and not Part B (most people with ESRD have Medicare).

You could always sell them to the patients for cash at cost. But the bigger question in my mind is, who has enough to be giving them to patients??? We don't even have enough for our medical staff.
We were considering using it when our doctors see patients in full PPE only. 🤷‍♀️ Not sure it would fly, so we haven't tried it. :unsure:
 

thomas7331

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We were considering using it when our doctors see patients in full PPE only. 🤷‍♀️ Not sure it would fly, so we haven't tried it. :unsure:
PPE supplies are usually considered part of a practice's overhead costs and most payers wouldn't reimburse this since since it is considered inclusive to the payments being made to the services that are rendered. For example, sterile gloves are not paid in addition to a surgical procedure. But I have seen some payer contracts that allow for payment for supplies that are above and beyond what is normally included in certain procedures - I'd suggest looking at your payers' policies and contracts for direction on this.
 
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kathiepa

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I read an article that you should be billing 99070 with a description of the extra equipment used, which we have been doing, but so far all insurances have been denying this line. Is anyone getting paid?
 

SharonCollachi

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Somewhere in these forums I posted information about insurance companies paying for extra costs for PPE during covid. It was mainly geared towards dentists. For instance, here is one link: https://success.ada.org/~/media/CPS/Files/COVID/PPE_Coding_Billing_Guidance.pdf

Also, remember that anyone who bills Medicare got a chunk of money back around March/April, without even asking for it or applying for it (it just showed up in your bank account from Optum, as they were charged with administering it, and was put into the account that Optum regularly deposits patient claims money in), and were eligible to ask for another chunk if they had continued costs (deadline to apply for 2nd wave was 6/3/2020). The reason I think that insurance companies are paying dentists directly is that they didn't get a chunk of the money based on Medicare billings. So, in effect, you really should have already been paid for this. Here is a link to that program info, I realize not everyone is involved in all aspects of a practice the way that I am and may not have known about this: https://www.hhs.gov/coronavirus/cares-act-provider-relief-fund/index.html

Also, on that page there is a place where you can check to see if your provider got the funds - there is a list of ALL providers available to anyone (no login or anything).
 

dstruve

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Is this going to be like 99070? Just because there is a code doesn't mean the carriers are going to pay us. I would be interested to see what is needed for documentation, what type of charge should be attached to it and who is actually going to pay it.
 
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●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.

Code 99072 may be reported with an in-person patient encounter for an office visit or other non-facility service, in which the implemented guidelines related to mitigating the transmission of the respiratory disease for which the PHE was declared are required. Use of this code is not dependent on a specific patient diagnosis. For a list of POS codes with facility/non-facility designations that are available in the Medicare Claims Processing Manual, visit https://www.cms.gov/Medicare/Coding/ place-of-service-codes. Question: What documentation is required to report code 99072? Answer: Given that code 99072 may only be reported during a PHE, one would not report this code in conjunction with an evaluation and management (E/M) service or procedure when a PHE is not in effect. Therefore, code 99072 is reported justifiably only when health and safety conditions applicable to a PHE require the type of supplies and additional clinical staff time explained in the code descriptor. Documentation requirements may vary among third-party payers and insurers; therefore, they should be contacted to determine their specifications.
 
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What amount is your office going use for the fee schedule for the 99072?

I have contacted Cigna, United HealthCare, and checked the CMS website for reimbursement. As of today the code has not been updated in their systems. We are charging $30 right now, but it is likely it will go down considerably as 99070 is charged at $6.00 per reimbursement is so low.
 
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