In outpatient physical therapy facilities understanding and navigating billable codes are important for business financial health. While patient care is the number one objective, maximizing reimbursement for practitioner time and operations is necessary for the overall success of the facility.  

Covid-19 has altered the way that outpatient physical therapy facilities run their day to day operations. Clinics have had to lower the amount of patients that they see in order to allow for increased  time spent on cleaning, donning/doffing PPE and maintaining social distancing in order to ensure a safe environment and adhere to health guidelines.  

In September 2020, the American Medical Association (AMA) recognized the impact that Covid-19 has had on outpatient businesses, by introducing a new CPT code: 99072. This code aims to take into account the added effort and time spent on maintaining a safe environment during the pandemic. 

Below is everything physical therapists, occupational therapists, and other outpatient facility practitioners need to know about CPT code 99072.

What is CPT code 99072?

CPT code 99072 is defined by the AMA as “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.” 

Actions that would fall under this code include: 

• Temperature checks
• Asking patients of Covid related symptoms prior to their visit 
• Donning/doffing PPE
• Cleaning equipment. 
  

This is an untimed code, meaning that it can only be used once per in-person visit per Provider Identification Number. 

Additionally, 99072 code can only be billed by an outpatient clinic, and is not eligible in other types of settings. Essentially, this code enables physical therapists and other clinic practitioners to recoup revenue losses resulting from the decreased time available for direct patient care. 

It is important for providers to not confuse code 99070 with the new 99072. 99070 is a CPT code that previously has existed and used by many providers that is described by the AMA: “supplies and materials that may be used or provided to patients during an office visit or other service(s) provided in the office setting...focuses on additional supplies provided over and above those usually included with a specific service...”  Even though they both relate to additional materials and supplies used, the key differences you need to know are:

• The new 99072 code is only used for when these actions are performed during a public health emergency. Once a public health emergency has ended, the code will no longer be able to be billable. 
  

• 99072  helps cover things like PPE and increased cleaning time done by clinical staff during a public health emergency, whereas 99070 focuses on supplies like IV, medications, etc. 
  

The AMA does state however, that both codes can technically be billed at the same time because each accounts for different focuses. 

In summary, the new CPT code 99072 is here to help cover the additional expenses of time and money that providers have acquired by attempting to maintain a safe environment for their patients during the Covid-19 pandemic. 

Now that we have provided some background information on the new code, below is more information on how to bill for it and reimbursement. 

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Billing CPT code 99072 in outpatient practices

As mentioned above, understanding and appreciating the process of billing and billable codes is essential for keeping outpatient facilities open and successful. Although code 99072 is new, the process of billing for it is not. As mentioned above it is an untimed code; providers can bill for 1 unit per in-person treatment session. The code does not have to be related to a diagnosis code, and therefore can be billed for any patient who requires the additional services that fall under the description of  99072. 

Documenting time spent on safety and health maintenance specific to the public health emergency may be important for organization and financial records within your practice but does not affect the amount of billable units for this code. Currently there is no requirement for any GP or GO modifiers. 

There is no consistency among third-party payers in terms of reimbursement for this code, and so it is important to reach out prior to billing with any questions pertaining to 99072. 

Will Insurance Companies Reimburse for CPT Code 99072?

At this time reimbursement for 99702 is inconsistent among third party payers. However, what we do know is that: 

• CMS considers 99072 to be a “bundled code” and they will not provide additional reimbursement for this code.  
• Insurance companies such as Blue Cross Blue Shield of Illinois, Advocate-Aurora Health Plan and United Health Care Texas have all stated that they will reimburse for 99072 (However, each company plans to reimburse in directions).
  

Due to this inconsistency in reimbursement and the potential for patients to be forwarded the bill, it is of utmost importance that providers contact insurance companies prior to billing for this code 99072. 

Providers must remember to follow their state laws and legislation on billing. If insurance companies do not reimburse for 99072, APTA states that the bill should NOT be forwarded on to the patient. Situations like this may arise, and it is important that providers remember to follow their state laws and legislation for billing. 

With CPT code 99072, providers now have the chance to get reimbursed for the additional hard work they have been putting in to keep their patients, staff and community safe during the Covid-19 Pandemic. Even though inconsistencies exist in terms of reimbursement for this code it does not negate the additional expenses that providers have acquired over the past several months. The increased expense on materials and supplies will unlikely go away in the near future. Post-Covid providers will likely continue to spend an increased amount of time on new hygiene protocols adopted across facilities. That being said, it is important for providers to educate themselves on the possibilities that exist for financial reimbursement. 

Using Healthie for physical therapy billing CPT codes

Healthie offers a cloud-based EHR and telehealth platform that is quick to implement while supporting compliance with HIPAA regulations — while being customizable to meet your business needs. In addition, the Healthie platform integrates with insurance billing tools, so that you can quickly create Superbills and CMS 1500 claims, send invoices, and collect payments for out-of-pocket services. 

Benefits for PTs: 

• Favorite CPT Codes: PTs can designate physical therapy-specific CPT codes as “favorites” within Healthie, allowing for quick access when filling out CMS-1500s
• Integration with Office Ally: Healthie’s integration with Office Ally makes it easy for PTs to submit and track insurance claims, saving them time and allowing them to spend more time focusing on clients
• Anatomical Charting: With our new Anatomical Charting feature, PTs can chart more accurately, therefore saving thm time when creating and submitting CMS-1500s
• Insurance Eligibility Tracker: Every insurance company has different coverage for physical therapy clients, so use Healthie’s Insurance Eligibility Tracker to effortlessly track your clients’ benefits and coverage. ‍
• Superbills: Have clients that have coverage with companies you are not in network with? Generate a Superbill for them to submit, or submit it to the payer on behalf of your client in hopes of receiving reimbursement.