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CMA joins coalition urging payors to reimburse for new CPT code 99072

November 17, 2020
Area(s) of Interest: Payor Issues and Reimbursement Advocacy 


On November 10, 2020, the California Medical Association (CMA) signed onto several coalition letters, spearheaded by the American Medical Association (AMA), urging payors across the nation to immediately adopt and pay for the new Current Procedural Terminology (CPT®) code, 99072. By signing the letter, CMA joined more than 100 organizations that cumulatively represent the hundreds of thousands of physicians who provide care for our nation’s patients every day.

AMA originally published CPT® code 99072 in September to meet the needs of the health care industry as medical advancements expanded the fight and protections against COVID-19. The CPT® code set update was approved by the CPT® Editorial Panel for immediate use.

CPT® code 99072 is used to report the additional practice expenses necessary to mitigate the transmission of COVID-19. 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 (PHE) as defined by law, due to respiratory-transmitted infectious disease. This code does not, however, include COVID-19 PCR sample collection kits.

While practices can technically bill for this code now, most payors have yet to adopt and reimburse for it. The coalition letters were written to urge payors – including Medicare, Cigna, Humana, Health Care Service Corporation, Blue Cross Blue Shield, Anthem, UnitedHealth Group and Aetna – to immediately implement and pay for CPT® code 99072 with no patient cost-sharing during the PHE. The coalition also urged America’s Health Insurance Plans (the national association of health insurance plans) to encourage its member plans to immediately implement and pay for this code. In the meantime, physicians should contact their contracted payors to determine whether they currently recognize the code, or plan on paying it in the future.

Implementation of CPT® 99072 is essential to protecting the viability of our nation’s health care workforce and alleviating the financial strain physicians now face. Both CMA and AMA have recently conducted surveys regarding physicians’ financial health, with both finding that physicians in California and across the nation continue to experience financial hardship as a direct result of the pandemic.

CMA’s most recent survey found that 87% of physician practices are still worried about their financial health. Even with more than 8 out of 10 practices now utilizing telehealth, the average volume of patient visits and practice revenue is still down by one-third, with 25% of practices still experiencing a revenue decline of 50% or greater. And, while revenue is down, practice costs have gone up 14%, with practices having to purchase personal protective equipment (PPE), comply with public health disinfecting guidelines, implement telehealth and make other changes due to the pandemic.

According to the AMA survey, 81% of surveyed physicians said revenue was still lower than pre-pandemic, with an average drop in revenue of 32%. Again, compounding the financial stress of lost revenue, practices are also incurring additional costs for heightened infection control protocols and PPE. Practice owners reported an average increase in PPE spending of 57% since February 2020, with 25% of owners saying that PPE expenses have risen at least 75%.

With physician practices already struggling with more than six months of decreased revenue, these increases in uncompensated costs only exacerbate the burden placed on the already strained health care system. Reimbursement of CPT® 99072 is essential to addressing and alleviating the significant financial pressures placed on physicians by the COVID-19 pandemic, and to ensure that our health care system remains open and accessible to patients across the state and nation.

More information regarding CPT® code 99072 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.

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