Everything Physical Therapists Need to Know About CPT 99072

Physical Therapists Need to Know About CPT 99072, a new CPT code (99072) to help clinicians seek compensation for the cost of providing medical care during the COVID-19 public health emergency)

The COVID 19 pandemic has put undue strain on the medical professionals and health workers across the country – emotionally, physically, and financially. In response to this, the American Medical Association (AMA) created a new CPT code – 99072 for use in non – facility settings for the expenses related to supplies, equipment, and staff time activities for visits performed during the public health emergency due to respiratory – transmitted infectious disease. The code became effective on September 8, 2020.

The official description for 99072 is, “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.”  (source)

The new code recognizes the additional phone and in-person time to screen patients for COVID-19 related symptoms and the additional cleaning and sanitation measures required. The code is not limited to pre-visit instructions and office arrival symptom checks that support the safe provision evaluation, treatment, or procedural service during this unprecedented time.

Everything PTs Need to Know About 99072

CPT 99072 does not require that the patient has a respiratory complaint or be diagnosed with COVID-19. It should only be reported when the service is rendered in a non – facility place of service (POS) setting and in an area where it is required to mitigate the transmission of the respiratory disease for which the PHE was declared. Other non – facility places of service could include home and domiciliary care service.

CPT 99072 should be reported only once per in–person patient encounter per provider identification number (PIN), regardless of the number of services rendered at that encounter. This can only be used during the PHE (e.g. COVID – 19 pandemic). Once the PHE has ended, the code will be invalid.

Billing this code does not require any modifiers, and it can be billed with any diagnosis code. 99072 is an untimed unit and outpatient providers can bill it once per in-person encounter. It does not have documentation requirements. However, it is recommended to document all infection control protocols, from administering patient questionnaires and cleaning shared areas to donning and doffing PPE. The American Academy of Orthopaedic Surgeons warns, that documentation requirements and coverage may vary among payers. So, rehab therapists should reach out to payers individually to know their documentation requirements.

Reimbursements: During its quarterly update to the Medicare Physician Fee Schedule the Centers for Medicare & Medicaid Services (CMS) announced that it does not currently plan to pay for 99072 i.e. it will not pay for this code through the end of 2020. The agency clarified that there are no relative value units (RVU) associated with 99072, which means there is no national payment standard for commercial or state payers to follow if they do choose to cover this code. Due to this ambiguity, commercial payers and state Medicaid programs have not come to a consensus about covering it.

Some payers have chosen to deny reimbursement, while others have reportedly chosen to pay for this code. Ardent medical billing services firms are always up to date with the code and can help you maximize your reimbursements.

As of Nov 2020, the California Medical Association (CMA) signed onto several coalition letters, spearheaded by the AMA, urging payers across the nation to immediately adopt and pay for CPT 99072.

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