You should be aware of a new payment code, 99072 that can be added on to every visit to compensate for the increased costs of providing care during the COVID-19 pandemic. This new code is designed to capture practice expenses including time over what is included in the primary service of clinical staff time (registered nurse [RN]/ licensed practical nurse [LPN]/ medical technical assistant [MTA]) to:
- conduct a pre-visit phone call to screen the patient (symptom check)
- provide instructions on social distancing during the visit
- check patients for symptoms upon arrival
- apply and remove PPE
- perform additional cleaning of the examination/procedure/imaging rooms, equipment, and supplies
This also designed to cover additional expenses for masks and cleaning materials required to keep your staff and patients safe during the pandemic.
The code is intended for patient visits and procedures performed in a non-facility location such as a physician’s office where physicians are responsible for their own office expenses (place of service 11). As such it is applicable to in person office visits, sick and well (or procedure related).
Some clearinghouses have not yet loaded the codes and there have been reports of rejecting claims, and that is expected to be addressed promptly. Some payers who are slow to add the code and value may go back and retroactively reprocess and pay claims that were submitted as of the effective CPT code implementation date. It is a good idea to start using the code and monitor right away.
The additional practice expense is $6.57 and this was obtained through survey and invoices supplied by specialty societies to the AMA Relative Value Update Committee. This information and a letter was sent to CMS. This is an add on code and does not require any modifier. Please negotiate payment for this code with your payers and be prepared to make sure your clearinghouses are ready to accept this new code that was emergently approved for use.
Use the AAP CPT assistant article and living COVID document as an easy to use reference for coding for COVID: https://downloads.aap.org/AAP/PDF/COVID%202020.pdf