Publication Date: 

The American Medical Association (AMA) released new CPT code 99072, which became effective on Sept. 8, 2020. The code is designed for practices to report expenses incurred during a Public Health Emergency (PHE), including supplies and additional clinical staff time.  

What this means for Blue Cross NC claims submissions: 

  • For Blue Cross NC commercial members (fully insured, State Health Plan, Inter-Plan Program Host members), providers can include code 99072 on the claim; however, payment will be considered “incident to” the course of diagnosis or treatment of a condition (i.e. furnished as an integral, although incidental, part of the physician’s personal professional services). As such, it will not be paid separately. 

  • Neither CMS nor the Federal Employee Program (FEP) has announced its reimbursement policies for 99072 for Medicare Advantage or FEP members. When they do, we will update this article.  

  • 99072 should only be reported when the service is rendered in a non-facility place of service (POS) setting and in an area where it is required to mitigate the transmission of the respiratory disease for which the PHE was declared. It should be reported only once per in-person patient encounter per provider identification number (PIN), regardless of the number of services rendered at that encounter. 

  • The code can only be used during a PHE (e.g. COVID-19 pandemic). Once a PHE has ended, the code will be invalid. 

Click here for more details on 99072 from the AMA CPT Assistant September 2020 update.