Steps to take in gaining payor approval and utilizing the code at your practice.
In the wake of COVID-19, many Applied Behavior Analysis (ABA) businesses quickly pivoted to a telehealth model in order to serve clients and prevent interruption to care. But now, with stay-at-home orders lifted, clinicians are seeing patients in-person – with treatment looking far different than it did prior to March 2020. Client treatment involves the use of personal protective equipment (PPE) and other preventative measures in accordance with the CDC.
Fortunately, there is good news on the horizon for clinicians. A recent update to the AMA Current Procedural Terminology (CPT®) code set has been approved for immediate use. One of the codes, CPT code 99072, relates to the additional supplies and clinical staff time required to perform safety protocols for the provision of evaluation, treatment or procedural services during a public health emergency in a setting where extra precautions are taken.
What is CPT code 99072?
CPT code 99072 is a new practice expense code that covers the additional supplies and clinical staff time providers use to help prevent the spread of COVID-19 while still providing safe in-person visits to clients. According to the AMA, the code covers COVID-19 related supplies, materials, and clinical staff time.
This includes patient symptom checks over the phone and upon arrival, donning and removing personal protective equipment (PPE), and increased sanitation measures to prevent the spread of communicable disease, as well as supplies and materials clinicians use to care for patients — all of which were formerly an out-of-pocket expense for practices.
According to the AMA, CPT code 99072 should be reported only once per in-person visit, per provider identification number (PIN), regardless of the number of services performed during the visit. The AMA also noted that it has submitted recommendations to the Centers for Medicare & Medicaid Services (CMS) to “inform payment” of the new CPT code.
Note: CPT code 99072 should only be used during a declared public health emergency. It is different from code 99070, which is typically reported for supplies and materials that may be used or provided to patients during normal office visits.
Using CPT code 99072: steps to take with payors.
First things first, you must gain approval from each of your funding sources to utilize this new CPT code. To gain approval, simply contact your payors to make any necessary adjustments and execute your contract amendment including the updates to fee schedules, and any other pertinent information or specific requirements that must be followed for you to successfully bill and get reimbursed for sessions in which you are using this new code. Going over these details will enable you to determine whether or not you will be able to successfully bill and get paid. It also prevents you from delaying your entire revenue cycle management process due to the improper use of the new code, while ensuring you don’t face recoupments during a payor initiated audit.
If you gain approval from payors, the next step is to confirm that your clients have the necessary coverage under their individual insurance policies. To do so, you will need to re-verify the client’s benefits, review their authorizations, and configure any limits that may be required. In summary: even if the payor has granted approval for you to use this new CPT code, it does not mean clients are necessarily covered. Re-verification of benefits and authorization updates are imperative and will set you up for successful billing and reimbursement down the line.
How the CentralReach system can help.
The CentralReach software has many built-in features that will enable a quick and effective transition to start billing with the 99072 code, including the ability to:
- Set up the new service codes and fee schedules based on your payor contracts.
- Limit the usage of codes in accordance with AMA guidelines and payor restrictions.
- Edit and update client appointments quickly to start taking advantage of the reimbursement of these costly expenses as your payor and client authorization updates occur.
- Quickly identify and track clients and appointments using the new billing code for effective reporting and analysis — including the use of custom labeling functionality across the system.
- Remain compliant with payor requirements and develop session notes for providers to complete upon each session. This will facilitate effective tracking and recording of all necessary information related to the new CPT code, per the payor requirement, and keep all documentation linked to client records.
- Continue billing processes by submitting all claims electronically (and billing more frequently) to improve cash flow.
To remain in-the-know with changing AMA procedures and COVID-19 related insurance changes, continue checking the AMA Public Health page (link: www.ama-assn.org/delivering-care/public-health) for the most recent information and updates.
In terms of what the future holds, AMA President Susan R. Bailey, M.D. stated, “The CPT code set continues to quickly adapt during the COVID-19 pandemic to streamline the reporting of innovative tools and services now available to help reduce the COVID-19 disease burden, improve health outcomes and reduce long-term care costs.
This update is the latest in a series of modifications to the CPT codes set to meet the needs of the healthcare industry as medical advancements expand the fight against COVID-19.”
Grow with CentralReach.
CentralReach started in 2012 as a BCBA’s solution to reduce practice management burdens. Today, CentralReach provides even more solutions that help hundreds of ABA practices streamline routine tasks, train and educate staff, and deliver excellent clinical care.