New CPT Code 99072 Usage and Coverage September 28, 2020Early this month, the American Medical Association (AMA) published an update to the Current Procedural Terminology (CPT) code set. The update includes the additional code “99072” as a response to measures adopted by medical practices and health care organizations to help prevent the spread of COVID-19, while continuing to provide high quality, in-person care to patients safely. The description for code 99072 is as follows: “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. Use 99072 only when safety measures are over and above those usually included during an office visit or service.”Although initiated and approved by the AMA, the Centers for Medicare and Medicaid Services (CMS) has yet to add the code to its fee schedule. We believe it is doubtful that this code will be covered by Federal, State or Commercial payers unless the PHE is extended into 2021. Until Medicare, Medicaid and Commercial Payers have made an official decision regarding covering code 99072 (if at all), we are advising practices interested in trying to bill for this CPT code, to consider running a test with each insurance company before implementing the code across all payers. In addition, the test will allow you to make sure all of your claims for each payer are not denied for an unrecognized CPT code on a claim. Closely monitor this code for insurance denials and make a decision as to how you will handle those denials when billing patients. For pricing, we suggest you calculate your costs for this extra work and price 99072 accordingly.As always, if you have any immediate questions about this new code, please contact Maureen West McCarthy at our medical practice consulting division, or your KatzAbosch representative.About KatzAbosch: Founded in 1969, KatzAbosch is one of the largest CPA and business consulting services in the Mid-Atlantic region. As an accounting firm, our mission is to provide the highest quality accounting, tax, financial and management consulting services to our regional clients. We understand the needs and challenges of our clients and we have made it our obligation to create, grow and protect asset value. KatzAbosch is consistently named a Best Accounting Firm to Work For in Accounting Today and has been named a Top 200 Accounting Firms in the Nation by Inside Public Accounting. Our firm is also ranked among the Top 15 Largest Accounting Firms in the Baltimore Area by the Baltimore Business Journal and a Top Workplace four times by The Baltimore Sun.