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The CPT® Code 99605 refers to a specific service provided by a pharmacist, known as medication therapy management (MTM). This service is characterized by a face-to-face interaction between the pharmacist and a new patient, lasting for an initial duration of 15 minutes. During this encounter, the pharmacist conducts a comprehensive assessment of the patient's medication therapy, which includes a thorough review of the patient's medical history and current medication profile. This profile encompasses both prescription and nonprescription medications, allowing the pharmacist to identify any potential drug interactions or medication-related problems that may affect the patient's health. The pharmacist's role is to optimize the patient's drug therapy, ensuring that the medications prescribed are effective and safe. This may involve making recommendations for adjustments to the medication regimen to enhance health outcomes and promote adherence to the treatment plan. It is important to note that this code is specifically designated for new patients, and there are additional codes available for established patients and for extended time spent on medication therapy management. For established patients, CPT® Code 99606 is used for a similar service lasting 15 minutes, while CPT® Code 99607 is applicable for each additional 15 minutes of service provided during either the initial or established patient encounter.
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The medication therapy management service represented by CPT® Code 99605 is indicated for patients who require a comprehensive review of their medication regimen. This service is particularly beneficial for individuals who may be experiencing complex medication therapies, have multiple prescriptions, or are at risk for medication-related issues. The following conditions may warrant the provision of this service:
The procedure for providing medication therapy management services under CPT® Code 99605 involves several key steps that ensure a comprehensive evaluation of the patient's medication needs. Each step is crucial for delivering effective care.
After the medication therapy management service is completed, the pharmacist may provide the patient with documentation summarizing the findings and recommendations made during the session. This documentation can serve as a reference for the patient and their healthcare providers. Additionally, the pharmacist may schedule follow-up appointments to monitor the patient's progress and make further adjustments to the medication therapy as needed. It is important for the patient to understand the significance of adhering to the recommendations provided and to communicate any concerns or side effects experienced with their medications. Continuous monitoring and support from the pharmacist can lead to improved health outcomes and better management of the patient's medication therapy.
| Short Descr | MTMS BY PHARM NP 15 MIN | Medium Descr | MEDICATION THERAPY INITIAL 15 MIN NEW PATIENT | Long Descr | Medication therapy management service(s) provided by a pharmacist, individual, face-to-face with patient, with assessment and intervention if provided; initial 15 minutes, new patient | Status Code | Statutory Exclusion (from MPFS, may be paid under other methodologies) | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 9 - Not Applicable | Multiple Procedures (51) | 9 - Concept does not apply. | Bilateral Surgery (50) | 9 - Concept does not apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 9 - Concept does not apply. | Co-Surgeons (62) | 9 - Concept does not apply. | Team Surgery (66) | 9 - Concept does not apply. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Non-Covered Service, not paid under OPPS | Type of Service (TOS) | 9 - Other Medical Items or Services | Berenson-Eggers TOS (BETOS) | M5D - Specialist - other | MUE | 0 | CCS Clinical Classification | 227 - Other diagnostic procedures (interview, evaluation, consultation) |
This is a primary code that can be used with these additional add-on codes.
| 99607 | Addon Code MPFS Status: Statutory exclusion (from MPFS, may be paid under other methodologies) APC E1 CPT Assistant Article Medication therapy management service(s) provided by a pharmacist, individual, face-to-face with patient, with assessment and intervention if provided; each additional 15 minutes (List separately in addition to code for primary service) |
| 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 93 | Synchronous telemedicine service rendered via telephone or other real-time interactive audio-only telecommunications system : synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional and a patient who is located away at a distant site from the physician or other qualified health care professional. the totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that is sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction. | 95 | Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system: synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional and a patient who is located at a distant site from the physician or other qualified health care professional. the totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that would be sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction. modifier 95 may only be appended to the services listed in appendix p. appendix p is the list of cpt codes for services that are typically performed face-to-face, but may be rendered via a real-time (synchronous) interactive audio and video telecommunications system. | GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit | GZ | Item or service expected to be denied as not reasonable and necessary | U1 | Medicaid level of care 1, as defined by each state |
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| 2011-01-01 | Changed | Short description changed. |
| 2008-01-01 | Added | First appearance in code book in 2008. |
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