New CPT codes for COVID-19 Test in 2021

AMA has added two new CPT code for COVID test, which have been approved for immediate use. The two new 2021 CPT code set are new medical testing services sparked by the public health response to the COVID-19 pandemic.

Below are the two new added CPT codes for COVID testing by AMA.

• CPT code 99072 allows for the provision of evaluation, treatment, or procedural services during a public health emergency in a setting where extra precautions are taken to ensure the safety of patients as well as healthcare professionals.
• 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.

These codes are effective immediately

By providing precise quantitative measurements, code 86413 is intended for use as an aid in investigating the presence and temporal evolution of the adaptive immune response to SARS-CoV-2. The aim of this quantitative antibody assay is to assist in studies of the epidemiology, pathogenesis, prevention, and treatment of COVID-19.

Code 99072 is to be reported only once per in-person patient encounter per provider identification number (PIN), regardless of the number of services rendered at that encounter. In the instance in which the noted clinical staff activities are performed by a physician or other qualified health care professional (eg, in practice environments without clinical staff or a shortage of available staff), the activity requirements of this code would be considered as having been met; however, the time spent should not be counted in any other time-based visit or service reported during the same encounter

Code 99072 may be reported with an in-person patient encounter for an office visit or other non-facility service, in which the implemented guidelines related to mitigating the transmission of the respiratory disease for which the PHE was declared are required. Use of this code is not dependent on a specific patient diagnosis.

Given that code 99072 may only be reported during a PHE, one would not report this code in conjunction with an evaluation and management (E/M) service or procedure when a PHE is not in effect. Therefore, code 99072 is reported justifiably only when health and safety conditions applicable to a PHE require the type of supplies and additional clinical staff time explained in the code descriptor. Documentation requirements may vary among third-party payers and insurers; therefore, they should be contacted to determine their specifications.

References:

https://www.asnc.org/

https://www.ama-assn.org/