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October 2020 Client Newsletter

New COVID Related CPT Codes

This will be of interest to all of our clients.

Two new CPT codes were created related to Public Health Emergencies (PHE), one of which (99072) will be relevant for all medical specialties with direct patient contact. The 86413 may be relevant for offices capable of such testing. Both are effective for dates of service September 8, 2020 and after.

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.

86413 - Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) antibody, quantitative.

The update to the CPT code set was approved by the CPT Editorial Panel, the independent body convened by the AMA with authority to expedite the review of proposed modifications and additions to the CPT code set. Both additions to the CPT code set have been approved for immediate use.

The first addition, CPT code 99072, was approved in response to sweeping measures adopted by medical practices and health care organizations to stem the spread of the novel coronavirus (SARS-CoV-2), while safely providing patients with access to high-quality care during in-person interactions with health care professionals. The additional supplies and clinical staff time to perform safety protocols described by code 99072 allow for the provision of evaluation, treatment or procedural services during a public health emergency in a setting where extra precautions are taken to ensure the safety of patients as well as health care professionals. The AMA/Specialty Society RVS Update Committee (RUC) worked with 50 national medical specialty societies and other organizations over the summer to collect data on the costs of maintaining safe medical offices during the public health emergency and submitted recommendations today to the Centers for Medicare and Medicaid Services to inform payment of code 99072.

The second addition, CPT code 86413, was approved in response to the development of laboratory tests that provide quantitative measurements of SARSCoV-2 antibodies, as opposed to a qualitative assessment (positive/negative) of SAR-CoV-2 antibodies provided by laboratory tests reported by other CPT codes. By measuring antibodies to SARS-CoV-2, the tests reported by 86413 can investigate a person's adaptive immune response to the virus and help access the effectiveness of treatments used against the infection.

However, there are 2 steps to getting paid:

  • Creation of CPT or HCPCS codes; and
  • Insurers agreeing to pay them.

Unfortunately there is no current requirement for insurers to cover these codes, though it would not be a surprise for Governors to require state approved insurers to do so during PHEs.

I expect these codes will be approved for payment at some point - and we are monitoring this daily. We will notify our clients as soon as we begin see approved fees. Stay tuned!

2020 Client Newsletter Archive