ADVOCATE FOR MASSAGE THERAPY AS A RECOGNIZED & RESPECTED HEALTHCARE PROFESSION
If you have been using CPT code 99072 to be reimbursed for PPE, you will probably have noticed that you are not being paid for it. If you look at the EOB’s, you will generally see a rejection notice that states: “payment is included in the allowance for another service/procedure”, or something similar to this. Healthcare providers across professions are not being reimbursed at this time.
Senate Substitute Bill 5169 (SSB5169) enables all healthcare providers to seek reimbursement for personal protective equipment during the state of emergency related to COVID-19. This bill became law and went into effect on April 16, 2021 when the governor signed it. Healthcare providers treating patients in state-regulated commercial health plans who have incurred costs for PPE are able to bill the newly created CPT code 99072 and be reimbursed $6.57 per patient encounter.
The two important things to remember about using 99072 to bill are:
It only applies to state-regulated commercial health plans which do not include: PIP, ERISA (federal plans such as medicare supplemental plans, or self-insured plans like Boeing or Microsoft), Taft-Hartley plans (trade-union bargained plans) or L&I.
Only bill exactly $6.57. Billing anything else gives the insurance companies an excuse to deny payment.
If you are unsure as to whether a client/patient’s plan is eligible for PPE reimbursement, ask your client/patient to contact their insurance company for a “summary plan description” which will indicate the set of laws that regulate it. By law, the insurance company has to respond to the patient’s request, but it does not have to respond to the same request if it comes from the healthcare provider.
CALL TO ACTION!
If you are being denied the PPE payment, our only recourse is to file complaints with the Office of the Insurance Commission (OIC). Without these complaints, nothing will be done by the OIC to require commercial health insurance companies to pay. Each healthcare profession is asking its members to file. To file a complaint, go to:
On the left of this page, below the picture is a link in a green field for “File a complaint or check complaint status”, click on that and then click on the “File Complaint” button on the next screen. To file a complaint, you need to provide specific information about your complaint. Provide claim number and date of service, never include the patient name as the complaint becomes public record. Complaints with patient names will be rejected. Provide a statement of having billed 99072 for $6.57, that it was rejected and provide the rejection reason. State that the insurance company is not following the SSB5167 signed into law on 4/16/21 and ask the Insurance Commissioner to make the insurance company follow the law and reimburse you.
Once you have filled out your first complaint and submitted it, if you file others, the form will remember the information from your prior complaint and fill it in, so all you have to do is update the information (claim number, service date, insurance company name etc) for the next complaint. The more complaints you file, the greater the weight is on the Insurance Commissioner to act. Please only include information for one massage service provided on each complaint.
Thank you for supporting your profession!
To learn more about the details of SSB5167, read a prior posting by clicking HERE.
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Advocate for Massage Therapy as a Recognized & Respected Healthcare Profession