New CPT Code 99072

Thank you for alerting us to the new CPT code 99072 during the last Business Impact Webinar.

I found this description online for those who would like it:

:●99072 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

We started using that code on all visits today- I am wondering if we should be using the modifier -59 or some other modifier? We sent half out with the 59 modifier, half without- and will see what happens. I’d love to hear what others think- especially our super-coders out there.


Hi- Which visit did you use the code ?

We started using the code on 9/19 and the claims were all denied because the insurance companies have not updated their systems so I recommend that you send out one days worth to see if you experience the same issue.

We are putting the code on all visits- and we know we are not likely to get paid yet, but if we start using the code it puts it on the radar of the insurance companies. I don’t expect to see anything for at least a week- but will let you all know what happens- We know we will get denials, or have to write it off if it is passed to the patients, but we feel it will advance the cause of getting paid fairly for the work and expense if we start coding for this. The code was put into place to help in an extraordinary time, and the insurance companies are holding on to a great deal of cash now which they will have to distribute in some way… maybe some of it can come to all of us.

How much are you charging ?

We are not allowed to discuss fees we charge- by law, with each other. But I believe Chip mentioned that the payment schedule for Medicare has an allotted amount of 6 dollars and change for this code. And that is publicly available info. We don’t take Medicare so I don’t have the exact number, maybe someone can tell us who knows? That ought to help us each set a reasonable fee for our practices individually.

Sorry that is what I meant to ask - thanks for all your help

Received notice from CareFirst today the CPT 99072 WILL NOT BE PAID! They will “revisit” with their “COVID taskforce” in “the fall and winter”. Billed and denied but will continue to bill.

Any visit that requires the use/need for PPE (N95, gown, goggles, face shield, gloves etc).

Got back our first denials, from United, but very interestingly they DID have a pricing on the denial- just said not covered. So they must be thinking about it as there was a fee on their end associated with the charge.

Is anyone putting any documentation in their notes about use of the code? If so what?

Our providers are billing for 99070. We were just alerted to the 99072 and have from the CO AAP that we might be able to begin using soon or by early Oct.

We got our first payment for the code today from Cigna.

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We are using it on all visits except for telemedicine due to increase costs from having an extra person check temps and escort people to rooms plus someone calling all patients the day before to review protocols and safety in addition to PPE.
Wrote Carefirst a letter with help from Dr Berman and others but it did not help.
Melissa Schwartz, M.D.

We are getting front end rejections from UHC and have not yet been paid by any other private insurer yet. Anyone gotten paid? I saw one person received from Cigna?

On the Cigna claim, did you use modifier 59? Thanks.


is anyone using modifiers?

That particular claim did not have a modifier. We are putting them on about half of the claims to see. Is anyone using it for just flu vaccine visits? We sent a few to see what happens. We “heard” some insurances will start paying after Oct 1. Anyone else hear this?

Anyone having issues with Anthem and code 99072? We have had entire claims kicked out because Anthem does not recognize the code. Anyone figure out a way around this?

Aloha from Maui,
We started last week sending all of our in office visits with the 99072 attached. I doubt that any insurer in the state will be paying, but as physicians we need to show that we do have additional costs to provide office care during the pandemic to protect the staff and the patients. Every other service industry can tack on a charge when they identify an increase in cost but not physicians (my office dumpster company charges me a fuel charge to drive to the office and a dumping charge for the cost at the landfill and they adjust the cost upward, even when the cost of gasoline went down. Our biological waste company charges a $50 dollar travel fee to pick up our sharps containers, but there is no other choice to get the containers to the company) We should not give up “just because” we historically know that they ignore the CPT codes when they want to, and then they will quote the CPT codes like the bible when they want to also. I hope that there are some pediatricians out there that have success to give us hope!

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