New CPT Code Now Available to Report COVID-19 PPE Costs

On September 8, 2020, the American Medical Association (AMA) released new Current Procedural Terminology (CPT®) code 99072 for reporting the cost of additional personal protective equipment (PPE), cleaning supplies, and clinician or clinical staff time needed to safely provide in-person services during the public health emergency (PHE).

99072  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

99072 captures the cost of supplies and activities required to mitigate the spread of COVID-19, including:

• time spent pre-screening patients before the visit and checking for symptoms onsite;
• PPE for the patient, clinician, and staff; and
• time and cleaning supplies for disinfecting equipment and rooms after each encounter.

Although 99072 describes “clinical staff time”, the AMA notes that the code can also be reported when a physician or other qualified health care professional performs activities normally carried out by clinical staff, such as pre-visit screening or equipment and room cleaning.

Clinicians should report 99072 only:

• during a local, state, or federally declared PHE due to a respiratory-transmitted infectious disease, such as COVID-19;
• once per in-person patient encounter per day, regardless of the number of services provided during that encounter; and
• when providing services in a non-facility setting, such as a private practice.

The new code is available for immediate reporting on claims. However, CMS has not yet announced whether it will cover 99072 for Medicare services. Clinicians should check with state Medicaid programs and commercial insurers, as it may take payers some time to implement the new code for payment.

CPT® code 99072 encompasses the additional supplies, materials, and clinical staff time required to support safe in-person patient interactions with healthcare professionals during the PHE for COVID-19. Unless extended, the PHE for COVID-19 expires Oct. 25.

As explained in a Sept. 8 CPT® Assistant Special Edition, use 99072 only when safety measures are over and above those usually included during an office visit or service (as opposed to CPT® code 99070, which covers supplies, materials, and time used during a typical office visit).

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).