Medical practices, including practices that treat injured or sick workers, have implemented numerous changes to safely treat patients in person during the COVID-19 pandemic. These additional safety precautions require practices to spend extra time with each patient and require the practice to provide extra safety supplies. Currently, practices are not reimbursed for the additional time and supply expenses incurred to treat patients at office locations.

To acknowledge the added safety expenses incurred by practices, the American Medical Association (AMA) added CPT 99072 as an additional Category I Current Procedural Terminology (CPT) for use during the COVID-19 Public Health Emergency.

However, in order to receive additional reimbursement for CPT 99072, providers of services to injured workers must wait for California’s Division Workers’ Compensation (DWC) to adopt this new CPT code, as well as the reimbursement amount for this CPT code.

The AMA provided substantive answers on requirements for billing CPT 99072, and the long descriptor for the added CPT 99072 is as follows:

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

Upon release by the AMA, the eagle-eyed DaisyBill community of workers’ comp professionals immediately inquired about the requirements to bill and the reimbursement amount for the code under California’s Official Medical Fee Schedule (OMFS).

Unfortunately for many workers’ comp providers, the Centers for Medicare and Medicaid Services (‘CMS’ or ‘Medicare’) has neither adopted CPT 99072 nor assigned RVUs to this CPT code.  

In California and several other states, the workers’ compensation fee schedule for physician services follows the lead of the CMS. While CPT 99072 exists and is reimbursed by some private insurers, for now CPT 99072 is not payable by Medicare and is not payable under the California Physician Services Fee Schedule.

We’ll issue an update if Medicare adopts this code and if, subsequently, the DWC adopts this code into the California OMFS. Until then, the best practice for obtaining reimbursement for the additional time and supplies spent in relation to the COVID-19 pandemic is a fee agreement under LC 5307.11.

Our DaisyWizard includes our Fee Schedule Calculator, which quickly calculates historical and current reimbursements for workers’ comp services. Enjoy a free trial of the DaisyWizard, and see what DaisyBill can do for your practice.

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