CurrentPremera BluecrossPolicy N/A

Personal Protective Equipment (PPE) reimbursement

Defines Premera Blue Cross's limitations on reimbursement for medical and dental personal protective equipment (PPE) submitted on professional claims; applies to Premera and affiliated lines of business and products.

Policy Summary

PayerPremera Bluecross

PolicyPersonal Protective Equipment (PPE) reimbursement

Policy CodePolicy N/A

Change TypeArchival (no material changes)

Effective DateOct 7, 2025

Next Review DateOct 7, 2025

Key ActionTreat PPE as bundled (Status B) and do not bill separately except for historical WA exception for code 99072 where allowed.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Archived 10/07/25archival status

99072code referenced

Multiple linesplan applicability

One-unit ruleWA exception

Coverage rules and historical exceptions

Covered when ALL of the following apply:

PPE worn as part of a dental or medical healthcare visit is considered part of business operations and practice expense included in the main procedure(s)/service performed and is not separately reimbursable.

Historical exceptions (WA only, time-limited)

During the federally declared public health emergency (PHE) and in compliance with Washington State Senate Bill 5169 (effective April 16, 2021 through July 7, 2023), code 99072 was reimbursed to Washington state healthcare providers only whose member benefits allowed reimbursement for this service.
One unit of code 99072 was reimbursed per Washington provider, per member, per date of service during the Washington exception period.
The Washington exception applied to Washington dentists and pharmacists only when billing medical services on CMS‑1500 paper or 837P professional claim forms; it did not apply to PPE billed as part of non-medical dental or pharmacy services (those remained bundled into the main procedure).

Policy Summary

PayerPremera Bluecross

PolicyPersonal Protective Equipment (PPE) reimbursement

Policy CodePolicy N/A

Change TypeArchival (no material changes)

Effective DateOct 7, 2025

Next Review DateOct 7, 2025

Key ActionTreat PPE as bundled (Status B) and do not bill separately except for historical WA exception for code 99072 where allowed.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Codes and historical unit rules

PPE (99072)CPTNot Covered

99072

Additional supplies, materials, and clinical staff time over and above those usually included in an office visit or other non-facility service(s), when performed during a Public Health Emergency due to respiratory-transmitted infectious disease; considered a Status B - Bundled service code and not separately reimbursed

Units reimbursed under WA exception — historical limit

Reimbursement limitOne unit reimbursed for code 99072 per Washington provider, per member, per date of service (historical exception).

Scope of exceptionApplied to Washington state healthcare providers only whose member benefits allow reimbursement (per WA SB 5169).

Applicable provider typesIncluded Washington dentists submitting medical services on CMS-1500 or 837P professional claims.

Exception time frameEffective for dates of service April 16, 2021 through July 7, 2023 (during the federally declared PHE).

Billing guidance and provider impact

Billing Rule

PPE billing (99072) — provider billing note

Code 99072 (Additional supplies, materials, and clinical staff time over and above those usually included in an office visit or other non-facility service(s), when performed during a Public Health Emergency due to respiratory-transmitted infectious disease) is considered Status B — bundled with the primary service and not separately reimbursable. Providers should not bill 99072 separately on professional claims for PPE used as part of dental or medical patient encounters unless a specific contract exception applies.

Affected code: 99072
Status: Status B — Bundled, not separately reimbursable
Exception: Reimbursement only when a provider or employer group contract explicitly dictates otherwise

Key definitions

Personal Protective Equipment (PPE) — definition

DefinitionPersonal Protective Equipment (PPE): Masks, gowns, gloves, face shields, shoe covers, protective barriers and cleaning protocols used to protect healthcare providers, both dental and medical, clinical staff and other qualified healthcare professionals during a patient encounter.

Included itemsMasks, gowns, gloves, face shields, shoe covers, protective barriers.

Also includesCleaning protocols used to protect healthcare providers during patient encounters.

Context of usePPE worn as part of a dental or medical healthcare visit is considered part of business operations and practice expense included in the main procedure; not separately reimbursable per policy.