We heard the AMA just created two more COVID specific CPT codes, what are the new codes and how are they used?
On September 8, 2020 the AMA announced the creation of CPT codes 86413 and 99072. For your convenience we have provided the long descriptions for each of the codes below.
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
86413: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) antibody, quantitative
Per the AMA, CPT 86413 is to be reported for laboratory tests that provide quantitative measurements of SARS-CoV-2 antibodies – as opposed to antibody tests that provide qualitative (positive/negative) results. CPT 99072 was created by the AMA to account for additional practice expenses related to patient safety measures adopted during the COVID-19 Public Health Emergency. However, it is important to note that per the AMA, CPT 99072 should only be reported in conjunction with services rendered in non-facility settings. Within its associated CPT Assistant Article, the AMA likens new CPT 99072 to existing CPT 99070 which is not reportable under the Medicare Outpatient Prospective Payment System and is bundled under the Medicare Physician Fee Schedule. For additional coding guidance as well as relevant clinical examples, please review the CPT Assistant Article linked below.
As always, we caution that there will be a delay for both Medicare and private payers to update their claims processing systems to accept these new codes. To avoid claim rejections and denials, we would advise checking with your individual MACs and/or commercial payers prior to claim submission to confirm code availability.
CPT Assistant Article for Codes 86413 & 99072: