AMA Announces New CPT Codes as COVID-19 Advancements Expand

The American Medical Association (AMA) has released an update to the Current Procedural Terminology (CPT®) code set today, introducing two new codes to report medical services related to the response to the COVID-19 pandemic.

The revision to the CPT code set has been sanctioned by the CPT Editorial Panel, an autonomous body assembled by the AMA with the authority to expedite the evaluation of proposed modifications and inclusions to the CPT code set. Both of the new codes have received immediate approval for utilization.

AMA President, stated, “The CPT code set is consistently adapting during the COVID-19 pandemic to facilitate the reporting of novel tools and services now accessible to mitigate the burden of COVID-19, enhance health outcomes, and decrease long-term care expenses. This update is the most recent in a series of alterations to the CPT codes set, aimed at meeting the requirements of the healthcare sector as medical progressions extend the battle against COVID-19.”

The initial addition, CPT code 99072, has been introduced as a reaction to extensive measures embraced by medical practices and healthcare institutions to curb the transmission of the novel coronavirus (SARS-CoV-2), while concurrently affording patients secure access to high-quality care during face-to-face interactions with medical professionals. The inclusion of supplementary supplies and clinical staff time to enact safety protocols, as outlined by CPT code 99072, facilitates the provision of evaluation, treatment, or procedural services during a public health emergency, within an environment where additional precautions are taken to ensure the safety of both patients and healthcare practitioners. The AMA/Specialty Society RVS Update Committee (RUC) collaborated with 50 national medical specialty societies and other organizations to accumulate data on the expenses related to maintaining secure medical facilities during the public health emergency. This data was then presented as recommendations to the Centers for Medicare and Medicaid Services, which would guide the payment structure for CPT code 99072.

The second addition, CPT code 86413, has been introduced in response to the development of laboratory tests that offer quantitative assessments of SARS-CoV-2 antibodies, in contrast to the qualitative evaluations (positive/negative) of SAR-CoV-2 antibodies provided by other existing CPT codes. By gauging the antibodies to SARS-CoV-2, the tests designated by CPT Code 86413 can explore an individual’s adaptive immune reaction to the virus and evaluate the efficacy of treatments administered against the infection.

For swift reference, the descriptions of the two novel Category I CPT codes are as follows:

1. CPT Code 99072: Additional supplies, materials, and clinical staff time beyond the usual allotment for an office visit or a non-facility service, conducted during a Public Health Emergency as legally defined, due to a respiratory-transmitted infectious disease.

2. CPT Code 86413: Quantitative assessment of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) antibodies.

In addition to the comprehensive descriptors, concise and intermediate descriptions for codes 99072 and 86413 can be accessed on the AMA website, along with several other recent modifications to the CPT code set that have facilitated the response to the SAR-CoV-2 virus and COVID-19.

Revisions to the CPT code set undergo an inclusive editorial procedure supervised by the CPT Editorial Panel, which acquires extensive input from the healthcare community and other spheres to ensure that CPT content mirrors the coding requirements of digital healthcare, precision medicine, augmented intelligence, and other aspects of a contemporary healthcare system. This thorough editorial process ensures that the CPT code set stays current with present-day medical science and technology, enabling it to fulfill its pivotal role as the trusted language of medicine today and in the future.