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The CPT® Code 99606 refers to a specific service provided by a pharmacist, known as medication therapy management (MTM). This service is designed for established patients and involves a face-to-face interaction between the pharmacist and the patient. During this initial 15-minute session, the pharmacist conducts a thorough assessment of the patient's medication regimen, which includes both prescription and nonprescription medications. The pharmacist reviews the patient's pertinent medical history and medication profile to identify any potential drug interactions or issues that may arise from the current therapy. This process is crucial for optimizing the patient's drug therapy, as it allows the pharmacist to make informed recommendations aimed at improving health outcomes. Additionally, the pharmacist plays a vital role in encouraging the patient to adhere to their prescribed treatment plan, thereby enhancing the overall effectiveness of the medication regimen. It is important to note that for new patients, a different code, 99605, is used for the initial 15-minute service, while 99607 is applicable for each additional 15 minutes of service provided during the encounter, whether for an initial or established patient.
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The medication therapy management service represented by CPT® Code 99606 is indicated for established patients who require a comprehensive review of their medication regimen. This service is particularly beneficial for patients who may be experiencing issues related to their medications, such as adverse drug reactions, ineffective therapy, or challenges with adherence to their prescribed treatment plans. The pharmacist's assessment aims to identify and resolve any medication-related problems, ensuring that the patient's therapy is optimized for better health outcomes.
The procedure for CPT® Code 99606 involves several key steps that the pharmacist follows during the medication therapy management session. Each step is crucial for ensuring a thorough evaluation and effective intervention.
After the medication therapy management session, the pharmacist may provide the patient with written documentation summarizing the recommendations made during the visit. This documentation serves as a reference for the patient and can be shared with other healthcare providers involved in the patient's care. The pharmacist may also schedule follow-up appointments to monitor the patient's progress and make further adjustments to the medication regimen as needed. Continuous communication between the pharmacist and the patient is essential for ensuring ongoing support and adherence to the treatment plan.
| Short Descr | MTMS BY PHARM EST 15 MIN | Medium Descr | MEDICATION THERAPY INITIAL 15 MIN ESTABLISHED PT | 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, established 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. | 25 | Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service: it may be necessary to indicate that on the day a procedure or service identified by a cpt code was performed, the patient's condition required a significant, separately identifiable e/m service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed. a significant, separately identifiable e/m service is defined or substantiated by documentation that satisfies the relevant criteria for the respective e/m service to be reported (see evaluation and management services guidelines for instructions on determining level of e/m service). the e/m service may be prompted by the symptom or condition for which the procedure and/or service was provided. as such, different diagnoses are not required for reporting of the e/m services on the same date. this circumstance may be reported by adding modifier 25 to the appropriate level of e/m service. note: this modifier is not used to report an e/m service that resulted in a decision to perform surgery. see modifier 57 for significant, separately identifiable non-e/m services, see modifier 59. | 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. | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | GW | Service not related to the hospice patient's terminal condition | GZ | Item or service expected to be denied as not reasonable and necessary | U1 | Medicaid level of care 1, as defined by each state | U3 | Medicaid level of care 3, as defined by each state | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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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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