Insights on new CPT code 99072

We have been receiving several inquiries about billing a new code 99072 which is a new CPT code designed to capture some of the extra costs that you are incurring in PPE and staff time related to COVID-19.

Janet and I have been investigating this code with multiple National and local payers, and we are engaged in discussions with the APTA Private Practice Section on advocating payment of this code.

To read more about the details of this code, you can click on the link below.

https://www.ama-assn.org/practice-management/cpt/covid-19-coding-and-guidance

Below is what we know so far.

1. Medicare has not priced this code and has not yet determined that they are going to pay for it.
2. Some of the National payers like Aetna have stated that they aren’t going to cover it, since it is a supply code and supplies are included in their reimbursement of other codes, and they do not pay for supplies separately.
3. Other payers have stated that they do not have that code programmed into their systems yet.
4. We have only heard of one isolated payment for this code by a Midwest BCBS plan, but we aren’t certain that is going to be a repeatable pattern.

Below are our concerns and unanswered questions about filing the code currently.

1. If you have a payer that limits you to 4 units, will they consider this one of the 4 units and kick one of your other interventions off the claim?
2. If a payer does not have this code programmed into their system, will it cause the entire claim to deny?
3. If you file a claim with this code, and it does deny, will it process to patient responsibility?
4. If the answer to 3 is yes, do you plan to pass that along to the patient, and if so, are you following all the steps necessary to do so (such as advanced notification, etc)? Or do you plan to “write that off” if it processes to patient responsibility, and if so how will that impact your typical statistics?

Here are our recommendations:

1. Call your major payers and ask them if they are allowing this code, and will they pay it if it is billed by PT/OT?
2. If you get an affirmative answer, then let your MBC representative know so that the code can be put in appropriately and use it with that payer.
3. Hold off on other payers until they confirm they are covering it.
4. If billing the code, include it in your documentation.

If you decide that you want to bill the code on every visit to all payers, regardless of their coverage, then please do the following.

1. Let your MBC representative know what your charge is for that code.
2. Let your MBC representative know how you want to handle denials for the code? (Adjust or bill the patient)
3. Include the code in your documentation.
4. If you are choosing to have the patient pay, then please make sure that you are doing the following:

• Notifying the patient of this charge and that you expect it to deny.
• Use an ABN for Medicare patients
• Have the patient acknowledge that they will be responsible for payment if/when it denies.
• Recognize the potential implications on customer service.

We are hopeful that more payers will begin to pick up this code and reimburse; however, payers typically don’t modify their systems with new codes until January, but COVID-19 has certainly not been the norm, so we are uncertain as to how this will play out.

Be aware that this code is only available during the National Health Emergency which expires in October – it is highly likely that deadline will be extended. This code has not been valued, so we are unable to recommend a price for it, so you should price it based on how much extra time and expense you incur for each visit related to COVID-19 precautions.