New U.S. CPT codes for COVID-19

On September 8, the AMA CPT Editorial Panel 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 first code, CPT code 99072, was approved in response to sweeping measures adopted by medical practices and health care organizations to stem the spread of the novel coronavirus (SARS-CoV-2), while safely providing patients with access to high-quality care during in-person interactions with health care professionals. The additional supplies, materials and clinical staff time identified in this code are for items intended to mitigate the transmission of the respiratory disease for which the PHE was declared. The new code is to be reported only once per in-person patient encounter per day regardless of the number of services rendered at that encounter, allowing for the provision of extra precautions to ensure the safety of patients as well as health care professionals.

The second addition, CPT code 86413, was approved in response to the development of laboratory tests that provide quantitative measurements of SARS-CoV-2 antibodies, as opposed to a qualitative assessment (positive/negative) of SAR-CoV-2 antibodies provided by laboratory tests reported by other CPT codes. By measuring antibodies to SARS-CoV-2, the tests reported by 86413 can investigate a person’s adaptive immune response to the virus and help access the effectiveness of treatments used against the infection.

For quick reference, the two new Category I CPT codes and long descriptors are:

  • 99072: 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.
  • 86413: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) antibody, quantitative

Please note CMS (or other payers) have not indicated they will cover these codes. ASE will monitor this very closely and update you on any developments