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).

The AMA worked with 50 specialty societies, including the American Speech-Language-Hearing Association (ASHA), to develop the new code. During this effort, over 4,600 audiologists and speech-language pathologists (SLPs) responded to an ASHA and AMA survey about the supplies and time required to maintain the safety of clinicians, patients, and clinical staff during the COVID-19 pandemic. The data collected helped inform AMA recommendations to the Centers for Medicare & Medicaid Services (CMS) regarding coverage and payment for the new code.

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—including an audiologist or SLP—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. ASHA is also advocating for payer coverage and implementation as soon as possible.

Resources

The AMA published detailed coding guidelines for 99072 in a special edition of the CPT Assistant [PDF]. ASHA will provide payment and coverage updates as more information becomes available.

Questions?

For more information, contact reimbursement@asha.org.