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CMS declines payment for code 99072

| December 21, 2020

CMS declines payment for code 99072

In September, the American Medical Association (AMA) approved new CPT code 99072 in an effort to help offset the extra expenses practices have incurred related to COVID-19. However, in the 2021 Medicare Physician Fee Schedule final rule, the Centers for Medicare and Medicaid Services (CMS), on an interim basis, declined to reimburse CPT code 99072 separately. Instead, CMS stated that payment for the items/services described by CPT code 99072 is “always bundled into payment for other services and payment for them is subsumed by the payment for the services to which they are incident.” This is an interim final rule, and CMS is accepting comments on this policy.

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CPT code 99072 is defined as “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.” The AMA asked CMS to reimburse the 99072 code at the RVS Update Committee-approved amount of $6.57.

 

CMS also elected not to provide separate reimbursement for CPT code 99072 in 2020. As a result, coverage by private payers, which tend to follow Medicare’s lead, has been spotty at best. In a recent poll of the Practice Management Committee, members said the code wasn’t being covered by commercial carriers or they weren’t billing for it. (There was one exception: a local BCBS plan in New York was reportedly reimbursing $1.67 for the code). A few Medical Group Management Association members, however, have reported receiving reimbursement for CPT code 99072. And some practices continue to bill the code despite not getting separate reimbursement, hoping for retroactive compensation if and when payment is approved. Given the inconsistency in commercial payer payment policies, the Advocacy Council recommends that you check with your payers regarding payment for CPT code 99072.

 

The College, along with the AMA and other medical societies, has advocated for the separate payment of CPT code 99072 by Medicare and commercial payers (UHG, Aetna, AHIP, Anthem, BCBS, Cigna, Health Care Service Corp. and Humana). The College will continue to support reimbursement for extra supplies and staff time related to COVID-19.

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