New CPT codes for MTM advances pharmacist billing efforts

Drug Store News,  Nov 12, 2007  by Jim Frederick

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ALEXANDRIA, Va. -- The pharmacy profession has scored a major breakthrough in its ongoing effort to provide and bill for professional patient-care services.

That breakthrough came when the American Medical Association approved the adoption of permanent, Category 1 status for a set of Current Procedural Terminology billing codes pharmacists can use to submit claims to prescription drug plans and other third-party payers for medication therapy management services.

In approving Category 1 status to three separate billing codes pharmacists can use for standardized billing for their MTM-related services to patients, the AMA made those codes a permanent part of widely recognized CPT billing codes. In a healthcare system that all too often fails to adequately reimburse pharmacists for anything but basic prescription dispensing, the AMA's action provides additional legitimacy and recognition to pharmacists' efforts to deliver--and get compensated for--MTM and related patient-care services.

In February 2005, the panel responded to a request by the Pharmacist Services Technical Advisory Coalition and approved a set of temporary billing codes pharmacists could use to submit claims for MTM services. The new, permanent MTM codes have been assigned new numbers pharmacists can use for billing, and are included in the recently released edition of the AMA's 2008 CPT manual.

"This is a major step forward that should expand pharmacists' ability to provide valuable professional services for their patients," noted PSTAC, which was instrumental in developing the MTM codes and in petitioning the AMA for CPT recognition. "Pharmacists should keep in mind that the current MTMS CPT codes will continue to be used for the remainder of 2007. The new codes are effective Jan. 1, 2008."

CPT codes are the standard used by healthcare providers for reporting professional services, laboratory tests and medical procedures in healthcare claims. Each CPT code consists of a narrative description of the patient intervention and an identifying code.

The new codes for pharmacy-delivered MTM services are as follows:

* CPT Code 99605 will be used for individual, face-to-face MTM services with a patient, provided by a pharmacist, "with assessment and intervention if provided."

* Code 99606 will be used for initial 15-minutes sessions with an established patient.

* Code 99607 is the proper claims code for each additional 15 minutes with the patient.

PSTAC, for its part, was founded in 2002 as a coalition of seven national pharmacy organizations. Its members include the National Association of Chain Drug Stores, the National Community Pharmacists Association, the American Pharmacists Association, the American College of Clinical Pharmacy, the Academy of Managed Care Pharmacy, the American Society of Consultant Pharmacists and the American Society of Health-System Pharmacists.

"The coalition has been successful at integrating pharmacists and their professional services into the traditional medical services billing model," the group noted in a report. "PSTAC provides the national leadership necessary to secure pharmacy's position in the national electronic data interchange environment related to health encounter/claims processing and payment of pharmacist professional services."

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