Skip to main content

You can lead Medicare to a code, but you can't make it pay.

Back in September, providers were encouraged when the American Medical Association announced it had updated its current procedural terminology code set to include a code for reporting expenses incurred as a result of the necessary public health response to the COVID-19 pandemic. The code — 99072 — was a new practice expense code that describes the additional supplies and clinical staff time required to provide safety measures during a public health emergency. In the current environment, it could be used to denote expenses related to stopping the spread of the coronavirus while still providing safe in-person visits.

Cut to Oct. 27, when the U.S. Centers for Medicare & Medicaid Services put the brakes on any additional payment directly related to the new code under Medicare.

In an MLN Matters update, the agency included 99072 among several codes that were being added to the 2020 Medicare Physician Fee Schedule, but with one important caveat: The code was assigned a "B" procedure status, meaning it is a bundled code and won't be associated with any relative value units and payment policy indicators won't apply.

"Basically, what CMS is saying is that this code doesn't warrant an additional payment on top of what providers are getting paid for the services rendered during that visit, " said Kara Gainer, APTA director of regulatory affairs. "Providers can still include it on the claim, but payment will be considered 'incident to' the treatment being provided that day, meaning that separate payment won't be provided."

According to Gainer, the commercial payment landscape is varied: some payers had already adopted this approach, others were waiting to see where Medicare landed, while still others are in fact paying on the code.

Our advice: Check with your state Medicaid programs and commercial insurers regarding eligibility for payment and coverage of the code.

Another important tip: Should a payer not adopt coverage for 99072, don't bill the cost associated with this code to the patient. And remember that providers must comply with state law, which could restrict the application of surcharges for additional supply expenses associated with the public health emergency.


You Might Also Like...

Roundup

APTA Adds Its Voice to Multi-Organization Advocacy Efforts

May 11, 2021

We're seizing opportunities to amplify our public policy messages — here's a sampling of some of the issue letters we've signed on to.

Roundup

APTA Coronavirus Update: May 5

May 5, 2021

PASC, post-COVID-19 neuropathy, herd immunity, and more.

Article

APTA Guidance: Mobility Device Clinical Documentation

May 5, 2021

As with other documentation of PT services, you must show the need for the care you provide and equipment you recommend.