September 18, 2020
The American Medical Association (AMA) has added two new codes to the Current Procedural Terminology (CPT®) code set to meet the needs of the health care industry as medical advancements expand the fight against COVID-19. The update to the CPT code set was approved by the CPT Editorial Panel for immediate use.
The first addition, CPT code 99072 is used to report the additional practice expenses necessary to mitigate the transmission of the novel coronavirus (SARS-CoV-2). This would include 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. This code does not, however, include COVID-19 PCR sample collection kits.
The AMA/Specialty Society RVS Update Committee 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 to the Centers for Medicare and Medicaid Services (CMS) to inform payment of code 99072. AMA is working with CMS to recognize and value the code.
While practices can technically start billing for this code now, physicians should contact to their contracted payors to determine whether they are (or plan to in the future) recognizing and paying this code.
The second new CPT code, 86413, was established to report quantitative antibody detection for SARS-CoV-2, 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 assess the effectiveness of treatments used against the infection.
More information regarding codes 99072 and 86413 can be found on the AMA website, along with several other recent modifications to the CPT code set that have helped streamline the public health response to the SAR-CoV-2 virus and the COVID-19 disease.