CPT Code 99072: Can Therapists Bill This Code?

September 22, 2020
Rick Gawenda

On September 8, 2020, the American Medical Association (AMA) published an update to the Current Procedural Terminology (CPT®) code set that includes two code additions for reporting medical services sparked by the public health response to the COVID-19 pandemic. The 2 new CPT codes have been approved for immediate use and are as follows:

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I hope you found this article and additional resource helpful. If CMS and other insurance carriers release updated information on the use and payment of this CPT code, I will update this article. Thank you for being a Gold Member!,

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  1. This article was very helpful, thank you. Maybe I missed it, but I’m unsure of the dollar amount I should be billing for 99072? Any insight?

    Thank you

  2. Thank you for this information. I wonder what the rationale was for excluding hospitals or those billing on UB04 when ALL providers in ALL settings are carrying out these processes/expenses.
    Thank you

  3. Do we have to use the 8 min rule when billing these codes or is this an untimed code?


  4. Can this be added retroactively – reprocess claims with this code added prior to 9/8/2020, since the PHE has been going for months? And are there known documentation requirements per patient to justify the use of this code? If not, do you have suggestions?

    1. The effective date of the code is September 8, 2020 per the AMA. What insurance carriers do with this code will be payer specific and you would have to check.

  5. The AMA article says “the code should be reported only once per in-person patient encounter (office visit or other service), regardless of the number of services provided during the visit…”. Does this mean we are allowed to bill one unit for each patient at each visit? Or just at the Eval only?

      1. Thank you! Do you know if 99072 requires an additional modifier, or just the GP or GO (for PT/OT)?

  6. We started to use this code and have not had any issues, however it is being rejected by Medicare. Do you know or have any suggestions on how we can get the claim processed even if they deny this code? The entire claim is being rejected.
    Thank you!

    1. Is the claim actually making it to your Medicare contractor or is the issue with your clearinghouse? If the latter, you need to discuss with them.

  7. The code is being rejected by the clearinghouse? Are there any suggestions on getting Medicare to accept the code even though it’s not yet payable? I’ve had no issues yet with other payers.

  8. Guidelines for use of PRF funds:
    • PRF funds can be used in the following manner and order:
    – Expenses attributable to coronavirus that are not reimbursed or obligated to be
    reimbursed from other sources

    Does billing this code create issues if you receive HHS PRD? As in, would you have to exclude from your expense reporting the dollars reimbursed by an insurance company?

  9. What documentation needs to be provided when a payer requests additional documentation for 99072?

  10. Have there been any changes to billing 99072? No payers are paying for now in 2021. I appreciate any input.

    Thank you!