With the advent of COVID-19 and other public health concerns, businesses and medical practitioners are turning to telehealth models to provide patients with basic treatments, without having them come into the clinical setting.

One of the biggest success stories of the telehealth trend has been for Applied Behavior Analysis practitioners. Many ABA practices were quick to adopt a telehealth model to serve clients and prevent interruption to care.

With the rules of patient involvement always in flux regarding PPE usage and other ways treatments can be administered, more and more clinicians are looking for ways to meet their client’s needs. This includes the ability to connect with patients one on one through the use of personal protection equipment.

Requesting PPEs and other similar supplies can be challenging for some practices. Though AMA Current Procedural Terminology hopes to help with new codes like CPT code 99072. This new code relates to the additional supplies and clinical staff time necessary to implement all required safety protocols for evaluations, treatments, and procedural services during a public health emergency like COVID-19.

What Is CPT Code 99072?

CPT code 99072 is a new type of expense code that serves to cover the additional supplies and clinical staff time clinicians need to help prevent the spread of COVID-19. They are considered essential to maintain safe in-person visits for patients, as well as safe operating conditions for practitioners and staff. This includes ABA therapists and administrative staff.

There are several tiers to the updated AMA CPT code requirements. It starts with performing a patient check-in either virtually, over the phone, or an in-person screening upon arrival. The goal is to report or detect any potential symptoms before an individual enters the clinical space. In some cases, this might require putting on personal protection equipment appropriate for the visit.

Before CPT Code 99072 clinicians were financially responsible for these measures, which were typically treated as an out-of-pocket expense related to operating their practice. With CPT Code 99072 these expenses can be reimbursed, through various reporting agencies including the Centers for Medicare and Medicaid Services.

Though it’s worth noting that there are some stipulations to how and when CPT Code 99072 is used.

  • It can only be reported only once per in-person visit.
  • The provider must assign an user identification number or PIN.
  • It can only be used during a declared public health emergency.
  • Payers need to be informed according to their own internal policies.

What Is Covered Under CPT Code 99072?

It’s important to note that CPT Code 99072 differs significantly from the older CPT Code 99070, which covered a wide array of injections and intravenous treatment. The AMA defines what is covered under CPT Code 99072 as:

Pre-Visit Phone Conversation

This is time over what is included in the primary service of clinical staff time, such as that administered by a Registered Nurse, Licensed Practical Nurse, or Medical Technical Assistant, as part of conducting a pre-visit phone call to screen a potential in-coming patient, as part of a symptom checking process. This includes providing the individual with social distancing guidelines during the clinical visit.

Arrival Symptom Check-In

This is the time and any possible materials used to check in-coming patients for symptoms upon arrival.

Cleaning Time And Materials

This is additional time and cleaning materials used to sanitize the clinical space before and after each appointment. This includes examination rooms, procedures, diagnostics, and imaging rooms.

Surgical Masks

CPT Code 99072 covers the use of up to three surgical masks as part of an individual practitioner or a technician’s personal protection equipment.

Cleaning Supplies

This includes additional quantities of hand sanitizer and disinfecting wipes, sprays, and other essential cleansers needed to properly sanitize all patient treatment areas.

How To Use CPT Code 99072?

There are a few important steps to be mindful of when using CPT Code 99072. It’s also important to note that the code isn’t specific to any professional specialty, treatment, or patient condition. Though it is available for billing by a physician, ABA therapists, or any other professional who meets the AMA’s definition of a qualified healthcare professional.

Get Approval From Payers CPT Code 99072

This requires contacting the payers directly to notify them that your ABA practice intends to use the code. This should include any necessary adjustments to make a contract amendment as well as updates to fee schedules. Advanced notification helps to significantly reduce the risk of claim denials or claim rejections as well as the delays that can occur for being reimbursed for the necessary supplies.

Ensure Clients Have The Necessary Coverage Pertinent To CPT Code 99072

With the advent of CPT Code, 99072 more and more payers and institutions are adding or amending clauses in client coverage. Though this is not the case for 100% of all client policies. With each new appointment verification or re-verification of the client’s benefits should be performed.

Make sure that the use of CPT Code 99072 is indeed covered. If it is not, make sure that the client is aware of it and that they might be responsible for the cost of PPEs and other measures needed to provide service. In some of these rare cases, the client might be able to contact their insurance provider in advance to have the necessary amendment made to their policy.

How Does The AMA Define A Qualified Healthcare Professional For Using CPT Code 99072?

The AMA defines a qualified healthcare professional like a physician or other qualified health care professional as an individual who is qualified by education, training, licensure, or regulation, who has received their medical credentials or is under the supervision of a credentialed professional. This could include medical students, those in residency, fellows, and clinical staff. Code 9972 also applies to a facility where care is being provided as a professional service.

Third-Party Medical Billing And CPT Code 99072

Many solo practitioners, small practices, clinics, and ABA practices are turning to third-party firms to handle their medical billing and coding. There are several benefits to this approach, as it frees up clinical staff to focus on patient care, which might include measures covered under Code 99072 for time or medical supplies.

If your ABA practice is thinking about outsourcing or is currently outsourcing your medical billing and other administrative needs to a third-party firm, make sure they are fully aware of how and when CPT Code 99072 is used. Make sure to include any special measures that your practice uses. This will help reduce medical billing code errors, and delays from insurance providers or other payers.

Benefits Of Third-Party Medical Billing

Reduction in administrative staff duties to allow for physicians, technicians, and staff to focus on treating patients and performing clinical sanitizing. It also helps with:

Ensuring Accurate Coding

Since medical billing specialists have a narrow administrative focus they are less likely to make coding errors.

Reduced Delays, Denials & Rejections

Accurate medical coding and correct use of CPT Code 99072 ensures that claims are processed efficiently and payers are submitting payments for a more consistent revenue stream.

Editing & Updating Patient Information

Prescreening creates an opportunity to update patient information, and identify the use for measures related to CPT Code 99072.

Continued Compliance

Insurance providers, Medicare & Medicaid all require compliance with CPT Code 99072 usage. Outsourcing to a third party ensures that the codes are being used correctly. This further helps with record tracking.

Conclusion

CPT Code 99072 represents one of the many steps being implemented throughout the healthcare industry to help patients and practitioners battle the COVID-19 pandemic. It’s a relatively new medical billing code, and some payers are still trying to implement it to the fullest effect. As an ABA practitioner familiarizing yourself with the finer points of Code 99072 will go a long way toward making sure it is entered correctly into your claims to insurance companies and institutions like Medicare and Medicaid.