Key Takeaways

Twenty-seven of Cindy Mrotek’s, LBS I, BCaBA, clients at ace Therapies, an Applied Behavior Analysis(ABA) clinic serving children and young adults with developmental disabilities she founded in the Chicagoland area, have Blue Cross Blue Shield insurance. However, despite billing the well-known insurance provider for the additional supplies, materials, and clinical staff time needed during the pandemic, all but three patients' policies have denied coverage.

“We don’t charge families out-of-pocket if their insurance doesn’t reimburse us,” Mrotek says. “But, I know many practices do.” In fact, Mrotek said she was charged an extra $10 to cover personal protective equipment (PPE) expenses before her daughter’s recent visit to the pediatrician.

What To Do If You’re Billed For a COVID-19 Test

The economic impact of COVID-19 does not discriminate; the legalities of insurance coding and the general issue of patient out-of-pocket costs associated with PPE are among the new realities of this era. A major debate is who should bear the burden of these extra costs necessary to practice COVID-19 safety precautions.

What This Means For You

Billing Insurance Companies

As Mrotek’s earlier example illustrates, the adoption of the CPT code 99072 from commercial insurance companies like Blue Cross Blue Shield continues to vary, even at the policy level. Tang said they have also tried billing various insurance companies with this new code, but were not reimbursed.

CPT Codes and How They Are Used

Doctors Are Coming Together to Share Costs

Home Healthcare Workers Feel Forgotten During COVID-19, Study Shows

Hochman founded the doctor-led, group-buying collectiveActionPPE, which he says has delivered more than 3 million units of FDA-certified PPE and medical supplies to independent and private practices in 40 states. “The use of group buying for PPE allows us to work together and keep prices 20 to 50% lower than the buying from big distributors,” he says. “Because we use the products ourselves, we are extraordinarily conscious of product quality and in tune to specific product shortages.”

Hochman added that the project wouldn’t have gotten off the ground without certain collaborations with medical associations. “The Charleston County Medical Society has been the greatest help and recognized the need, allowing the ActionPPE project to launch into a free-standing company," he says. “The Wisconsin Medical Society and the Arizona Medical Association also jumped onboard early helping us snowball into the national effort we are today.”

What PPE Shortages are Expected in 2021?At the beginning of the pandemic, the highest in-demand and most difficult to track down PPE were masks. However, Hochman says now that mask production is at an all-time high and vaccines have started to roll out, the PPE demand has shifted.“We are now seeing that gloves (non-sterile), syringes, needles, and lightweight disposable gowns are getting harder to source,” he says.

What PPE Shortages are Expected in 2021?

At the beginning of the pandemic, the highest in-demand and most difficult to track down PPE were masks. However, Hochman says now that mask production is at an all-time high and vaccines have started to roll out, the PPE demand has shifted.“We are now seeing that gloves (non-sterile), syringes, needles, and lightweight disposable gowns are getting harder to source,” he says.

At the beginning of the pandemic, the highest in-demand and most difficult to track down PPE were masks. However, Hochman says now that mask production is at an all-time high and vaccines have started to roll out, the PPE demand has shifted.

“We are now seeing that gloves (non-sterile), syringes, needles, and lightweight disposable gowns are getting harder to source,” he says.

Organizations Advocating for PPE Reimbursement

Many specialty medical organizations such as the American Physical Therapy Association (APTA), the American Academy of Pediatrics, and the American Academy of Family Physicians (AAFP) have undertaken extensive advocacy efforts to ensure their members are paid appropriately for PPE expenses, including calling on CMS and private insurance carriers to take action immediately.

Healthcare Workers Are 7 Times More Likely To Develop Severe COVID-19

This act would give small businesses and 501(c)(3) non-profit organizations a tax credit up to $25,000 for the cost of qualified personal protective equipment such as:

Hochman, Tang, and Mrotek all agree tax credits would be more helpful than restrictive loans and would make more sense for those like themselves who are in private practice. As President Joe Biden takes charge, there is the potential for tax changes.

How 3D Printing Is Scaling Up COVID-19 Protection

“Currently, all PPE will be written off as normal operating expenses,” Mrotek says, after meeting with her business accountant on February 2. “The IRS is not issuing PPE credits for PPE, although my accountant thinks they should.”

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit ourcoronavirus news page.

4 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Medical Association.AMA announces new CPT codes as COVID-19 advancements expand.Centers for Medicare and Medicaid Services.RVU20D.American Physical Therapy Association.CMS won’t pay out on new code for additional pandemic costs.American Academy of Family Physicians.Academy lauds bill that would relieve some PPE expenses.

4 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Medical Association.AMA announces new CPT codes as COVID-19 advancements expand.Centers for Medicare and Medicaid Services.RVU20D.American Physical Therapy Association.CMS won’t pay out on new code for additional pandemic costs.American Academy of Family Physicians.Academy lauds bill that would relieve some PPE expenses.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

American Medical Association.AMA announces new CPT codes as COVID-19 advancements expand.Centers for Medicare and Medicaid Services.RVU20D.American Physical Therapy Association.CMS won’t pay out on new code for additional pandemic costs.American Academy of Family Physicians.Academy lauds bill that would relieve some PPE expenses.

American Medical Association.AMA announces new CPT codes as COVID-19 advancements expand.

Centers for Medicare and Medicaid Services.RVU20D.

American Physical Therapy Association.CMS won’t pay out on new code for additional pandemic costs.

American Academy of Family Physicians.Academy lauds bill that would relieve some PPE expenses.

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