Wiki Pharmacist Coding

[johnsonw]

Can anyone tell me your experience with coding 99605-99607 Pharmacist drug management services? If a pharmacist spends an hour with a patient going over how to take the drug and all the interactions and precautions I think they should be reimbursed. Appreciate your help and experiences.

 

[Thelly27]

I feel that based off the cpt description, this code shouldn't be billed if its just your run of the mill review of medications before dispensation to the patient. As you have described the pharmacist spending a great deal of time discussing proper usage of this drug with the patient for up to an hour based off the medical history(need for the drug), and associated risks, given the circumstance I would think it warrants billing 99605-99607. you may want to just double check on the insurance portion...although this may be a billable service, you may want to double check and see if the payer that patient has will cover this. although the pharmacist is spending the time, if the patient gets a bill that could be an issue down the line.

 

[Pam Warren]

These codes may be used only if you are a provider with Part D. I've attached a document that explains that Medication Therapy Management codes are not covered under Part B, as a pharmacist is not recognized as a provider, nor are these codes covered under Part B.

When we bill for a pharmacist (in our practice setting) we may only bill 99211, as long as all incident-to guidelines are met. This does incur deductible/copay/coinsurance for patients.