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The CPT® Code 99607 refers to a specific service provided by a pharmacist, which is known as medication therapy management (MTM). This service is delivered in a face-to-face setting with the patient, allowing for a personalized approach to medication management. During this interaction, the pharmacist conducts a thorough assessment of the patient's medication regimen, which includes both prescription and over-the-counter medications. The primary goal of this service is to identify any potential drug interactions, side effects, or other medication-related problems that may affect the patient's health. The pharmacist then works to optimize the patient's drug therapy, making necessary adjustments to enhance therapeutic outcomes. This may involve recommending changes to the medication regimen, providing education on proper medication use, and encouraging adherence to the prescribed treatment plan. It is important to note that this code is used to bill for each additional 15 minutes of MTM services provided, following the initial service codes 99605 for new patients and 99606 for established patients.
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The medication therapy management service represented by CPT® Code 99607 is indicated for patients who require comprehensive medication reviews and management. This service is particularly beneficial for individuals with complex medication regimens, those experiencing medication-related problems, or patients who may have difficulty adhering to their prescribed treatment plans. The following conditions may warrant the use of this service:
The procedure for providing medication therapy management services under CPT® Code 99607 involves several key steps that ensure a thorough evaluation and optimization of the patient's medication therapy. Each step is crucial for delivering effective patient care.
After the medication therapy management service is completed, the patient may be advised on follow-up appointments to monitor their progress and the effectiveness of any changes made to their medication regimen. The pharmacist may also provide additional educational materials or resources to support the patient's understanding and adherence to their treatment plan. Continuous communication between the pharmacist and the patient is encouraged to address any further questions or concerns that may arise. Additionally, the pharmacist may collaborate with other healthcare providers to ensure a coordinated approach to the patient's overall care.
| Short Descr | MTMS BY PHARM ADDL 15 MIN | Medium Descr | MEDICATION THERAPY EACH ADDITIONAL 15 MIN | Long Descr | 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) | 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 an add-on code that must be used in conjunction with one of these primary codes.
| 99605 | 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; initial 15 minutes, new patient | 99606 | 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; initial 15 minutes, established patient |
| 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. | GW | Service not related to the hospice patient's terminal condition | GZ | Item or service expected to be denied as not reasonable and necessary |
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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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