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No Coverage for CPT Code 99072, Personal Protective Equipment

Audience: Participating Physicians and Dentists

As we have previously communicated, the Health Plan does not reimburse for personal protective equipment, supplies, or materials, as they are considered inclusive to the service provided. This includes non-coverage of CPT code 99072, used to bill for additional supplies, materials, and clinical staff time during the Public Health Emergency.

We are updating our claims system to deny 99072 as inclusive, but while we operationalize the inclusive denial rationale, some claims that have already processed will default to a $0 allowance. We will adjust any claims submitted with CPT code 99072 for dates of service beginning September 8, 2020. There is no action required on your part; adjustments will happen automatically.

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