Senate Bill 5169, requiring commercial insurance carriers to reimburse for personal protective equipment (PPE) costs during COVID-19, was signed into law April 16, 2021. The bill applies to services incurred from April 16 through the end of the federal public health emergency, which has now been extended to at least July 20, 2021.
Under the bill, health care providers as defined in RCW 48.43.005 can bill state-regulated commercial health plans the newly created CPT code 99072 for PPE costs and be reimbursed $6.57 per patient encounter as a separate expense.
(26) “Health care provider” or “provider” means:
(a) A person regulated under Title 18 or chapter 70.127 RCW, to practice health or health-related services or otherwise practicing health care services in this state consistent with state law; or
(b) An employee or agent of a person described in (a) of this subsection, acting in the course and scope of his or her employment.
Insurers, other than fully insured state regulated commercial health plans, are not required to cover the service as a separate expense. The bill does not address institutional billings from health care facilities, including outpatient departments and provider-based clinics. The definition of provider in RCW 48.43.005 is limited to professional billings on CMS 1500 forms.
WSHA believes it is appropriate to bill the additional code when the billing entity is incurring the cost of the PPE and there is no separate billing for the supply, for example in the case of freestanding clinics operated by a hospital where the only billing is the professional billing. SB 5169 does not address PPE supplies billed as part of the facility institutional billing. (Andrew Busz, AndrewB@wsha.org)