Effective 9/8/20: AMA Issues 2 New COVID CPT® Codes

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The American Medical Association (AMA) issued two new CPT® codes effective September 8, 2020.  The press release can be found here.

The New Codes

  • 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

What you need to know

CPT® 86413 is to report quantitative antibody testing.  This test is to determine if a patient has an antibody as a result of a previous infection of COVID-19.

It has been recognized the public health emergency (PHE) has substantially increased operating costs with the requirement of PPE.  To help capture those costs, CPT® 99072 was created.

Place of Service Restriction – Use of 99072 is limited to reporting in a non-facility place-of-service and is an area required to mitigate the transmission of the respiratory disease declared by the PHE.

How to report 99072

Code 99072 should not be confused with 99070.  Code 99072 does not replace 99070.  The new code (99072) is to capture additional practice expenses during the PHE.  Reporting 99072 can only be reported: (1) during a PHE and (2) only for additional items required to support a safe in-person service or treatment.  CPT® 99070 is not associated exclusively with a PHE and focuses on additional supplies provided beyond those usually included in the service.

What you need to do

Practices and hospitals will need to manually update appropriate fee schedules and EMRs to ensure capturing of the codes.

Do payors pay for these codes?

It is too early to know.  Directly contacting the payor is best regarding their rules and potential reimbursement amount.