Is anyone coding for and getting reimbursed for PPE? 99070 is the code that was mentioned in this forum, my biller says it’s not specific enough, she’s states she needs a HCPCS code specific for PPE for COVID-19 or insurance will reject it. Any input would be appreciated.
I am not having luck with that code. I agree with her but have not looked into a HCPCS.
We have had zero luck with 99070, we billed it for weeks.
We have not been getting paid.
We haven’t gotten any payments for PPE either. Is anyone passing on the cost to your patients?
Is anyone using a modifier when billing, @Jan? Do you know the HCPCS?
The costs of the gowns have gone up and are outrageous now. Our local EMA has given us some N95s, but they won’t last forever.
Tanya Fitts, MD
Lafayette Pediatric Clinic
I dont know that it’s use is acknowledged by many payers, but modifier -CR (Catastrophe / Disaster related) would describe the reason for the use of PPE.
I found only one HCPCS and that one seems intended for personal safety from violence (S9381 Delivery or service to high risk areas requiring escort or extra protection, per visit)
Depending upon the reasons for non-payment, is this a job for the AAP’s PPA/Hassle Factor Folks? AAP’s Coding for COVID-19 and Non-Direct Care advice includes ammo for distinguishing PPE from what’s typically required to render services.
No reimbursements-we’ve tried multiple codes/modifiers.
This really upsets me–how are we supposed to see sick children when we are spending so much in time and resources securing protective equipment?
I agree, this should be passed on to the AAP as part of our advocacy.
has anyone used a ‘facility charge’? If it works for the hospitals/free standing ER’s, then are we allowed to use the code?
Has anyone asked the coding hotline?
does your list not cover the cost of an N- 95 mask?
Facility charges are part of your credentialing with insurance companies. You can’t suddenly start charging them. Other than clinics who are credentialed as urgent cares, independent pediatric practices by and large are not “facilities.”
Besides, facility fees draw intense ire and mocking.
During the period when most care was being given by telemed (where office overhead was substantially LOWER than in-person services), it didn’t make sense to lobby for PPE charges. Now, even though kids are expected to go back to the office, and we have to wear protective gear for nearly everything, it makes sense to lobby your payers to turn on 99070. The national AAP is working on this, as well as local Pediatric Councils.
Any other ideas as to how to get reimbursed for PPE?
See what the NY Pediatric Councils are doing and find out how you can help.
Use PPE designed for reuse, like elastomeric respirators, durable goggles, and washable isolation gowns.