2025 CPT code 99072
(Deleted) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Medicine - Special Services, Procedures and Reports Medicine Services and Procedures > Special Services, Procedures and Reports Feed
Additional supplies, materials, and clinical staff time beyond those typically included in an office visit or other non-facility service, during a Public Health Emergency due to a respiratory-transmitted infectious disease.
Modifiers were generally not applied to this code.
The medical necessity is established by the need to mitigate the transmission of a respiratory-transmitted infectious disease during a declared PHE. The additional resources must directly contribute to infection control and the safe provision of healthcare services in an in-person setting.
The physician or other qualified healthcare professional is responsible for ensuring the safety of both patients and staff during the PHE by implementing and documenting the use of additional supplies and staff time to mitigate transmission of the respiratory illness. This may include pre-visit instructions, symptom checks, appropriate use of PPE, and enhanced cleaning protocols.
- Medicine Services and Procedures > Special Services, Procedures and Reports
- Medicine Services and Procedures > Special Services, Procedures and Reports
In simple words: This code covers extra costs a doctor's office has during a public health emergency caused by a respiratory illness (like a pandemic).These costs include things like extra cleaning supplies and staff time for keeping everyone safe from infection. The code is used only once per patient visit, even if multiple services are performed that day.
CPT code 99072 reports additional practice expenses incurred during a Public Health Emergency (PHE) as defined by law, due to a respiratory-transmitted infectious disease.These expenses cover supplies (e.g., face masks, cleaning supplies) and clinical staff time exceeding what's usual for office visits or other non-facility services.The extra resources must directly mitigate disease transmission during in-person encounters.This code is reported only once per in-person patient encounter per day, per provider, regardless of the number of services provided. If a physician performs the extra duties instead of clinical staff, the code still applies; however, the time spent should not be double-counted in other time-based codes for that encounter.
Example 1: A patient presents for a routine checkup during a respiratory virus pandemic. The physician uses extra time for pre-visit phone screening, implements enhanced infection control measures (increased cleaning, PPE use), and documents these actions. Code 99072 is reported along with the E/M code., A patient arrives at the urgent care clinic with flu-like symptoms during a flu pandemic. The staff checks the patient's temperature and symptoms before allowing entry, conducts the visit in a designated isolation room, and uses extra PPE.99072 is reported with the appropriate visit code., A physician performs multiple procedures on a patient in an office setting during a COVID-19 surge. Due to the PHE, enhanced infection control measures were implemented (including extra staff time for cleaning and additional PPE).99072 is reported in addition to the procedure codes.
Detailed documentation supporting the medical necessity of the additional supplies and staff time is crucial. This should include:specific types and quantities of supplies used; time spent on infection control procedures (pre-visit calls, enhanced cleaning, PPE); and a statement clarifying that these were above and beyond the usual practice expenses.Documentation should reflect compliance with relevant guidelines and regulations during the PHE.
** CMS initially included the code in the 2020 Medicare Physician Fee Schedule but assigned it a "B" status, indicating it was bundled and not separately reimbursed.Providers should verify reimbursement policies with individual payers.The code was intended for use only during a declared Public Health Emergency for a respiratory-transmitted infectious disease.
- Revenue Code: Y1 (OTHER - MEDICARE FEE SCHEDULE)
- RVU: Initially assigned a "B" procedure status by CMS, meaning it was bundled and didn't receive separate payment under Medicare.Payment may have varied among other payers.
- Global Days: Not applicable.
- Payment Status: Initially active, but later deemed bundled and not separately payable under Medicare. Payment status varied with other payers.
- Modifier TC rule: Not applicable.
- Fee Schedule: The initial fee schedule was established upon the code's release but was not separately payable under Medicare.Fee schedules varied among other payers.
- Specialties:All specialties providing in-person patient care during a PHE related to a respiratory-transmitted infectious disease.
- Place of Service:Office, Urgent Care Facility, other non-facility settings where in-person patient care is provided.