July 8, 2021

OIC Responds to Carrier Non-Payment of New PPE CPT Code 99072

The WSMA recently expressed concerns to the Washington State Office of the Insurance Commissioner regarding carrier noncompliance under recently enacted Senate Bill 5169, which requires commercial carriers to reimburse for PPE costs during the pandemic. The OIC has taken a number of steps in response to our concerns.

After receiving our letter on behalf of health care stakeholders, the OIC conducted outreach to plans it regulates, to clarify that the legislation applies to all fully insured health plans and to ensure they are paying CPT 99072 as per the legislation. A few carriers informed the agency that the IT changes necessary to process the claims were not in place when the legislation went into effect, but the programming has since been completed and claims initially denied/delayed are being successfully reprocessed. Additionally, the OIC has provided "How to determine health plan fully insured status," a chart with instructions from carriers on how to identify what entity regulates their plans.

If you are still having PPE claims denied by fully insured health plans, the OIC recommends you file a complaint using its online complaint form.