Potential code for COVID patients – Code is active but not covered by most payers.

CPT Code 99072 was created by the CPT Panel in response to these extra practice expenses associated with patient care during the Public Health Emergency.  CPT 99072 can be used to report the additional materials such as extra cleaning supplies, face masks, personal protective equipment, thermometers and clinical staff time, including but not limited to pre-visit instructions and office arrival symptom checks that support the safe provision of evaluation, treatment, or procedural service during this unprecedented time.   This code can be used in conjunction with office visits and other non-facility service(s) when the office visit or other non-facility service(s) are rendered during the Public Health Emergency (PHE), as defined by law, if the practice itself incurs such expenses.  Unless extended, the current PHE for COVID-19 is scheduled to expire on October 25, 2020.

When reporting CPT code 99072, practices should report the code only once per in-person patient encounter per day regardless of the number of services rendered at that encounter. Code 99072 may be reported during a PHE when the additional clinical staff duties as described are performed by the physician or other qualified health care professional in lieu of clinical staff.  

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).  

Coverage for this code is not yet established with most payers.  Proposed payment to Medicare is around $6 but not yet allowed as the overall cost to Medicare would be significant and of course the cost is currently being absorbed unfairly by your practice.  

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Mark N. Painter is a managing Partner of PRS Consulting, LLC, the CEO of PRS, LLC and the Vice President of Coding and Reimbursement Information for Physician Reimbursement Systems, Inc. (PRS). Since co-founding PRS in 1989, Mr. Painter has served as the primary coding resource for the PRS products including Hotlines, Coding Manuals and quick reference tools, the Internet based application codingtoday.com and seminars. He has lectured to a variety of groups concerned with health care reimbursement. Mr. Painter's extensive knowledge of physician reimbursement issues has allowed him to assist insurance companies, physicians and their staff members, legal counsel, actuaries, Specialty Societies and consultants on a daily basis. He has serves has an expert to legal counsel, bio device companies and pharmaceuticals. He was a co-chair of the Colorado Clean Claims Task Force, a committee of nationally known industry experts charged with the development of single payment edit database for the state. Mr. Painter is a CPMA. Mr. Painter received his B.A. from Grinnell College at Grinnell, Iowa.