Tag: #PPE

Posted in Training, Updates

NY STATE DFS PPE (99072) letter- patients are not responsible.

Posted on by KR2Medical Billing

Update: Oxford/UHC/ NYSHIP (Empire Plan) and 1199 DO NOT PAY FOR THIS CODE.

As of 09/08/20-there is a new CPT code 99072 became available for PPE.

Definition 99072:

Additional supplies, materials, and preparation time required and provided by the physician or other qualified health care professional and/or clinical staff over and above those usually included in an office visit or other service(s), when performed during a nationally declared public health emergency due to respiratory transmitted infectious disease.

Coding Guidelines:

Code 99072 is to be reported only once per in-person patient encounter per provider identification number, regardless of the number of services rendered at that encounter.

Code 99072 is designed to capture the following practice expense factors:

  • Time over what is included in the primary service of clinical staff time to conduct a pre-visit phone call to screen the patient (symptom check), provide instructions on social distancing during the visit, check patients for symptoms upon arrival, apply and remove personal protective equipment, and additional cleaning of the examination/procedure/imaging rooms, equipment and supplies
  • Three surgical masks
  • Additional cleaning supplies (e.g., hand sanitizers, disinfectant wipes)

HOWEVER, as of 09/09/2020 as per NY STATE DOH there was a letter sent out to providers from various insurance payers: Anthem BCBS (Empire), MVP, EmblemHealth warned providers not to collect any copay, coinsurance for PPE.

IF the patient was charged for PPE, the provider has to refund they should issue a refund to members immediately and contact your Empire Network Services representative to report the following:

  • Member(s) impacted
  • Total refunded to member(s)
  • The refund process

Below are the links to the announcements that were went to the NY providers from above mentioned insurance payers/ NY DFS Letter :

  1. EmblemHealth Coronavirus (COVID-19) Update | EmblemHealth
  2. Empire BCBS (Anthem) NY Providers Communication
  3. MVP FAX Provider Communication
  4. NY Provider Communications New York Department of Financial Services (“DFS”)

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Posted in Training, Updates

Texas UniteHealthCare Community Plan – new code for PPE

Posted on by KR2Medical Billing

On 08/10/2020  Texas Medicaid & Healthcare Partnership (TMHP)  made an announcement that:

Effective for dates of service on or after April 1, 2020, procedure code S8301 for infection control supplies above and beyond normal protocol will become a benefit for Texas Medicaid.

Procedure code S8301 may be reported for any encounter in which personal protective equipment (PPE) above and beyond normal protocol is required to safely treat a patient with or without a diagnosis of COVID-19.

Procedure code S8301 is reimbursed, in accordance with 1 TAC §355.8023.

Billing Guidelines:

Submitting claims- the providers may continue to bill as they normally do, but with these claims, they  must submit copies of the appropriate receipts or invoices. Standard claims filing deadlines apply. Prior authorization is not required, but claims are subject to retrospective review.

When submitting the claims through Link, providers may submit receipts or invoices as attachments once the claim status says “Pending.” To learn more about checking claim status and adding attachments, go to UHCprovider.com/claims >Check Claim Status: Quick Reference, Tutorials and More > Self-Paced User Guide.

Previously submitted claims

If you’ve already submitted claims using procedure code S8301, with dates of service on or after April 1, 2020, your claims will be automatically reprocessed. Please don’t resubmit these claims.

Important:  “above and beyond normal protocol?”

According to TMHP, commonly used supplies for a service or procedure are not considered “above and beyond normal protocol.” If gloves alone are enough under normal circumstances, that’s considered “normal protocol.” Any PPE used, in addition to the gloves in this example, would be considered “above and beyond normal protocol.”

 Reimbursement: The reimbursement rate for this code is 35 percent of billed charges.

For more information, please visit the following links:

For the whole Texas COVID-19 Clarification Letter, please click here.

Procedure Code Addition and Update for Coronavirus (COVID-19) | TMHP info