CMS Makes Payment Decision Regarding 99072

November 5, 2020
Rick Gawenda

On September 8, 2020, the American Medical Association released CPT code 99072 and this code became effective immediately. I have previously published 2 articles on this CPT code. The first was on September 22, 2020 titled “CPT Code 99072: Can Therapists Bill This Code“? and the second was published on October 12, 2020 and titled “CPT Code 99072: Things to Think About“.

At the time both articles were published, the Centers for Medicare and Medicaid Services (CMS) had not made a determination yet on whether they would pay for this CPT code. Well now, CMS has made that decision.

CMS has assigned CPT code 99072 Procedure Status

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  1. So is there a higher dollar amount on active or passive codes to reflect this? Are you saying bill 99072 with the other codes to have it included in the other codes, or don’t bill it at all, because it is automatically included?

    1. Think of it the same as a hot or cold pack under Medicare. There is no increase in payment of the other CPT codes.

      1. So Rick …document 99072 in your note but do not attach a fee? or just continue as we were as if the code didn’t exist?

        1. I am not going to bill it just like I do not bill hot and cold packs. We document that they have received but this isn’t billed.

      2. So, this is CMS way to deny the code legally but it shows that CMS acknowledges the code. They acknowledge it, but won’t pay for it. Not surprising when 9% cut is coming up quickly. Thanks Rick.

        1. No insurance carrier, including the Medicare program, is required to pay for every CPT code created by the American Medical Association (AMA). The AMA creates the codes, but payers determine which codes they will pay for and for which disciplines.