Washington Law Requires Reimbursement for PPE

Governor Inslee signed SB 5169 on April 16, which requires commercial payers to reimburse providers for PPE used during in-person patient encounters.

Q - When did the law take effect and when will it expire?
A - The law took effect as soon as Governor Inslee signed it on Friday, April 16, 2021 and all patient encounters on April 16 are covered by the new law. An emergency clause allowed it to take effect immediately. It will expire when the COVID-19 health emergency ends and we don't know that date yet (possibly the end of 2021).

Q - How much reimbursement does the law require for each in-person patient encounter?
A - $6.72. But you do not need to change or lower your fee schedule to this amount when requesting reimbursement.

Q - What CPT code should I use when requesting reimbursement?
A - 99072

Q - Are there any insurance providers that are not required to reimburse me under this new law?
A - Yes. This new law applies to commercial insurance plans only; it does not apply to self-funded plans, Medicaid, or plans under SEBB and PEBB.

Q - Does the law require documentation in the patient's record regarding PPE use?
A - No but we recommend you do so anyway.