The American Medical Association (AMA) has published an update to the Current Procedural Terminology (CPT) code set that includes two Category 1 code additions for reporting medical services in response to the public health response to the COVID-19 pandemic. These codes have been sent to the Centers for Medicare & Medicaid Services (CMS) for review and approval for payment.
The new CPT code 99072 was established to report additional practice expenses incurred during the Public Health Emergency (PHE), including supplies and additional clinical staff time. The new CPT code 86413 was established to report quantitative antibody detection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Both additions to the code set have been approved by the AMA for immediate use.
Code 99072 is used to report the additional supplies, materials, and clinical staff time over and above the practice expense(s) included in an office visit or other non-facility service(s) when the office visit or other non-facility service(s) are rendered during a Public Health Emergency (PHE), as defined by law, due to respiratory-transmitted infectious disease. These required additional supplies, materials, and clinical staff time are intended to mitigate the transmission of the respiratory disease for which the PHE was declared. These include, but are not limited to, additional supplies, such as face masks and cleaning supplies, as well as clinical staff time for activities such as pre-visit instructions and office arrival symptom checks that support the safe provision of evaluation, treatment, or procedural service(s) during the respiratory infection-focused PHE. When reporting 99072, report only once per in-person patient encounter per day regardless of the number of services rendered at that encounter. Code 99072 may be reported during a PHE when the additional clinical staff duties as described are performed by the physician or other qualified health care professional in lieu of clinical staff.
The long descriptors for both codes are:
• 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 the Public Health Emergency as defined by law, due to respiratory-transmitted infectious disease
• 86413 - Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) antibody, quantitative
Additional coding and guidance information, including the short and medium descriptors, can be accessed on the AMA website, along with several other recent modifications to the CPT code set that have helped streamline the public health response to SARS-CoV-2 and COVID-19. The AUA will provide more information as it becomes available.
At this point, it is unclear if anyone is reimbursing for this code. Please check with your Medicare contractor and insurers.