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PPE Reimbursements - SSB 5169 Status & Documents 7/1/2021

July 01, 2021 8:22 AM | Shelley Dahle (Administrator)

"WAEMA has been coordinating with the Office of the Insurance Commissioner (OIC) and the other health professional associations regarding the new law requiring many insurers to pay for PPE expenses during the COVID crisis. Many claims for PPE sent by our profession have gone unpaid, some legitimately and some not. The OIC has been fielding many inquiries about unpaid PPE claims, and has been working to try and resolve the improperly denied claims for PPE.

As you probably know at this point, as of April 17th, we are allowed to bill the insurance companies $6.57 for PPE expenses using CPT code 99072. The law includes only plans where the insurance company is regulated by Washington state and where the payer is the insurance company themselves. A lot of confusion has arisen due to the fact that the ultimate payer is not always known.

Many visits for which you bill for PPE may be denied when: 1) The policy is written in another state OR 2) The insurance company is only acting as an administrator for a union, government, or business who ultimately pays for the claim.

To assist you with identifying which plans are self-insured plans for which PPE will not be paid, the OIC has shared these documents with us (provided below). Please review them to assist you with following up on unpaid 99072 claims."

SB 5169 provider determination of plan funding type

PPE reimbursement under SSB 5169

OIC - health carrier plan status

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About WAEMA

The Washington Acupuncture and Eastern Medicine Association first began as the Acupuncture Association of Washington over 35 years ago. The organization helped to provide a unified legislative voice for our profession. In fact, our founders were integral in helping establish the legal practice of Eastern Medicine in Washington state. Our all-volunteer Board of Directors currently consists of 7 democratically elected professionals in the field.