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AMA Unveils New CPT Code for Additional Expenses during PHE

AMA Unveils New CPT Code for Additional Expenses during PHE

The American Medical Association (AMA) recently released a new CPT code intended to be billed for additional expenses incurred because of the COVID-19 public health emergency (PHE). Starting with September 8, 2020, dates of service, the code, 99072, can account for both additional clinical staff time as well as additional supplies required specifically because of the PHE during office-based visits.

What to Use It For

Specifically, the code should be used for “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.”

According to the AMA, examples of additional clinical staff time include those incurred for “patient symptom checks over the phone and upon arrival, donning and removing personal protective equipment (PPE), and increased sanitation measures to prevent the spread of communicable disease.” Supplies included under 99072 include surgical masks, hand sanitizer, disinfecting wipes, sprays, and cleansers.

When to Use It

A special edition of the CPT Assistant Guide indicates that providers can bill 99072 only once per in-person patient encounter per provider identification number, regardless of the number of services rendered at that encounter. If a physician or other qualified healthcare professional performs these additional activities themselves, they are allowed to bill 99072 but the time spent “should not be counted in any other time-based visit or service reported during the same encounter.”

While the organization released the code in conjunction with the COVID-19 PHE, 99072 will remain available for any future declared PHEs as well.

How to Document It

While documentation guidelines will vary by payer and have not been elaborated on by the AMA, providers should plan to document at least the primary components of the code description itself, such as:

  • Additional time spent by the staff, including patient symptom checks over the phone and upon arrival, donning and removing personal protective equipment (PPE), and increased sanitation measures to prevent the spread of communicable disease.
  • Additional supplies and materials used, including surgical masks, hand sanitizer, disinfecting wipes, sprays, and cleansers.

The DOS should be sufficient to establish that a declared PHE was in place, however, a note indicating that the additional time and supplies were used as a result of a declared PHE couldn’t hurt.

Who Will Pay For It

It’s not yet clear which, if any, payers will reimburse for the new code. The AMA has submitted the code to the Centers for Medicare and Medicaid Services to see if they will cover it, though a decision has not yet been announced. In the event CMS does approve payment for the code retroactively through the code’s effective day, office-based providers should consider beginning to use it now on appropriate claims.

99072 vs 99070

The new code is similar to another code also used to report additional supplies. However, 99072 differs from existing CPT code 99070 in a few ways. 

For one, 99070 is used to report additional supplies “provided over and above those usually included with a specific service, such as drugs, intravenous (IV) catheters, or trays,” whereas 99072 is “reported only during a PHE and only for additional items required to support a safe in-person provision of evaluation, treatment, or procedural service(s).” 

As well, 99072 also can be used to “account for the additional time required by clinical staff to provide the service safely,” whereas 99070 is for the supplies only. 

Learn More

For more information about new CPT 99072, review the following documents:

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Charity Singleton Craig

Charity Singleton Craig is a freelance writer and editor who provides communications and marketing services for CIPROMS. She is responsible for creating, editing, and managing all content, design, and interaction on the company website and social media channels in order to promote CIPROMS as a thought leader in healthcare billing and management.

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