MTMS Billing Codes Approved for Pharmacists

SEPTEMBER 01, 2005

The Pharmacist Services Technical Advisory Coalition has been given a set of HIPAA-compliant billing codes for pharmacists to use to bill third-party payers when providing Medication Therapy Management Services (MTMS). The codes will be used to bill any health plan that provides a benefit for MTMS, including those covered under the new Medicare Part D Prescription Drug Benefit.

Under the codes parameters, third-party payers will be billed only for MTMS performed face-to-face between a pharmacist and a patient. Services performed by the pharmacist may include providing education and training; monitoring medication compliance; modifying therapy; administering medication; and formulating a treatment and/or follow-up plan.

As with documentation requirements for other health care providers, specific elements are necessary to verify the service provided and are dependent on the type and level of MTMS. The elements include review of the pertinent patient medical history; medication profile (prescription and nonprescription); and intervention and recommendations for optimizing medication therapy.


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