How To Use CPT Code 99605

CPT 99605 describes the medication therapy management service provided by a pharmacist to a new patient, involving a face-to-face interaction for an initial 15 minutes. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 99605?

CPT 99605 can be used to describe the medication therapy management service provided by a pharmacist to a new patient. This code is used when the pharmacist conducts a face-to-face evaluation with the patient for an initial 15 minutes, focusing on factors such as the patient’s medical history and medication list.

2. Official Description

The official description of CPT code 99605 is: ‘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.’

3. Procedure

1. The pharmacist meets the new patient face-to-face.
2. The pharmacist reviews the patient’s medical history and creates a medication profile.
3. If appropriate, the pharmacist suggests ways to improve medication compliance and achieve optimal results.
4. The pharmacist considers the patient’s medical conditions, complete medication list, mental comprehension, and caregiver support.
5. The pharmacist provides advice to enhance patient and caregiver understanding of the medication, with the goal of preventing adverse effects.
6. This code represents the first 15 minutes of the session.

4. Qualifying circumstances

Patients eligible to receive CPT 99605 services are new patients who require medication therapy management. The pharmacist must conduct a face-to-face evaluation with the patient, taking into account their medical history, medication list, mental comprehension, and caregiver support. The goal is to improve patient understanding of their medication and prevent adverse effects.

5. When to use CPT code 99605

CPT code 99605 should be used when a pharmacist provides a face-to-face medication therapy management service to a new patient for an initial 15 minutes. This code is not appropriate for established patients or for sessions lasting longer than 15 minutes.

6. Documentation requirements

To support a claim for CPT 99605, the pharmacist must document the following information:

• Patient’s medical history and medication list
• Creation of a medication profile
• Date and duration of the face-to-face session
• Assessment and intervention provided during the session
• Recommendations made to improve medication compliance and understanding
• Signature of the pharmacist providing the service

7. Billing guidelines

When billing for CPT 99605, ensure that the service is provided by a pharmacist to a new patient in a face-to-face setting for an initial 15 minutes. This code should not be reported with other codes unless additional time is spent with the patient, in which case CPT code 99606 or 99607 should be used. It is important to consider the location of the service when coding medication therapy management.

8. Historical information

CPT 99605 was added to the Current Procedural Terminology system on January 1, 2008. There have been no updates to the code since its addition.

9. Examples

1. A pharmacist conducting a face-to-face medication therapy management session with a new patient, reviewing their medical history and providing recommendations for optimal medication use.
2. A pharmacist meeting a new patient to create a medication profile and educate them on potential drug interactions during a 15-minute session.
3. A pharmacist assessing a new patient’s medication list and suggesting ways to improve medication compliance and prevent adverse effects in a face-to-face session.
4. A pharmacist providing medication therapy management to a new patient, considering their medical conditions and caregiver support, and offering advice on medication usage during a 15-minute session.
5. A pharmacist conducting a face-to-face evaluation with a new patient, taking into account their mental comprehension and providing guidance on medication administration and potential side effects.
6. A pharmacist meeting a new patient to discuss their medication history and providing education on proper medication usage and potential drug interactions during a 15-minute session.
7. A pharmacist reviewing a new patient’s medical history and medication list, creating a medication profile, and offering recommendations for improved medication compliance during a face-to-face session.
8. A pharmacist conducting a medication therapy management session with a new patient, considering their caregiver support and providing guidance on medication administration and potential adverse effects in a 15-minute session.
9. A pharmacist meeting a new patient to assess their medication list and offering advice on medication compliance and potential drug interactions during a face-to-face session.
10. A pharmacist conducting a face-to-face evaluation with a new patient, reviewing their medical history and providing education on proper medication usage and potential side effects during a 15-minute session.