Part B Insider (Multispecialty) Coding Alert

Published on Thu Mar 20, 2008 PDF

Tip: You can't bill an E/M just for handing a refill to a patient

Question: May we bill an in-surance carrier for a prescription refill, especially for patients who have to physically stop at the office to pick up a script? This is very time-consuming for our practice, and we-d like to know which code Medicare will reimburse.

Answer: Unfortunately, Medi-care will not reimburse you for prescription pickups. CPT specifically includes writing prescriptions as part of an E/M service. This is just part of the cost of seeing patients, much like office supplies. There is no CPT code that payers will reimburse for writing a prescription.

If the only reason the patient comes in is to pick up a prescription and the physician does not see her for a documented E/M service, you cannot bill an E/M code.

Note: Prescription drug management supports a -moderate- level of risk, according to the table of risk in the E/M documentation guidelines. Although prescription drug management is not a separately billable service, it can help to support a higher service level when your physician does see the patient for a documented E/M visit that includes prescription management. You should associate a moderate level of risk with a level-four established patient office visit, 99214. (Remember, 99214 also requires either a detailed history or a detailed exam.)