CPT Code 99072: Things to Think About

On September 22, 2020, I published an article titled “CPT Code 99072: Can Therapists Bill This Code?” In this article, I will answer the following questions:

1. Can I support the added costs of supplies and materials in my book-keeping?
2. Can I support the added clinical time for that visit in my documentation?
3. If I am paid a per visit rate for each therapy visit, will billing this CPT code be included in that payment or will it be an extra dollar amount?
4. If I am limited to 4 units per visit and 99072 is my 5^th unit that visit, will I get paid for all 5 units, just the traditional 4 units or will the insurance carrier replace 1 unit of a therapeutic intervention with 99072 and hence, reduce my reimbursement for that visit?
5. If the code is denied and insurance carrier shifts it to patient responsibility, and a clinic waives it, are you inducing a patient, or exceeding the “gift” threshold?
6. Is the Medicare program paying for this CPT code?
7. What is the Medicare allowed amount for CPT code 99072?
8. Is CPT code 99072 a timed or untimed code?
9. When can CPT code 99072 be billed?
10. What setting(s) can this code be utilized in?

Question
Can I support the added costs of supplies and materials in my book-keeping?

Answer

Question
Can I support the added clinical time for that visit in my documentation?

Answer

Question
If I am paid a per visit rate for each therapy visit, will billing this CPT code be included in that payment or will it be an extra dollar amount?

Answer

Question
If I am limited to 4 units per visit and 99072 is my 5^th unit that visit, will I get paid for all 5 units, just the traditional 4 units or will the insurance carrier replace 1 unit of a therapeutic intervention with 99072 and hence, reduce my reimbursement for that visit?

Answer

Question
If the code is denied and insurance carrier shifts it to patient responsibility, and a clinic waives it, are you inducing a patient, or exceeding the “gift” threshold?

Answer

Question
Is the Medicare program paying for this CPT code?

Answer

Question
What is the Medicare allowed amount for CPT code 99072?

Answer

Question
Is CPT code 99072 a timed or untimed code?

Answer

Question
When can CPT code 99072 be billed?

Answer

Question
What setting(s) can this code be utilized in?

Answer

I hope you found this article helpful and informative concerning CPT code 99072. Thank you for being a Gold Member!