How To Use CPT Code 99606

CPT 99606 describes the medication therapy management service provided by a pharmacist to an established patient in a face-to-face setting, with an initial duration of 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 99606?

CPT 99606 can be used to describe the medication therapy management service provided by a pharmacist to an established patient. This service involves a face-to-face interaction between the pharmacist and the patient, with a focus on assessing the patient’s medication needs and providing intervention if necessary. The initial duration of this service is 15 minutes.

2. Official Description

The official description of CPT code 99606 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, established patient.’

3. Procedure

1. The pharmacist meets with the established patient in person for a medication therapy management session.
2. The pharmacist reviews the patient’s medical history and medication list to gain a comprehensive understanding of their medication needs.
3. Based on the patient’s specific circumstances, the pharmacist creates a medication profile and assesses the patient’s compliance with their prescriptions.
4. If necessary, the pharmacist provides intervention strategies to help the patient improve their medication compliance and achieve optimal results from their medications.
5. The pharmacist takes into account the patient’s medical conditions, mental comprehension, and caregiver support when providing advice and recommendations.
6. This code represents the first 15 minutes of the medication therapy management session.

4. Qualifying circumstances

CPT 99606 is applicable to established patients who require medication therapy management services. The pharmacist assesses the patient’s medication needs based on their medical history and medication list. Factors such as the patient’s medical conditions, mental comprehension, and caregiver support are taken into account during the session. The service is provided in a face-to-face setting for an initial duration of 15 minutes.

5. When to use CPT code 99606

CPT code 99606 should be used when a pharmacist provides medication therapy management services to an established patient in a face-to-face setting. This code is specifically for the initial 15 minutes of the session. If additional time is spent with the patient, additional codes (such as 99607) should be used to represent each additional 15-minute increment.

6. Documentation requirements

To support a claim for CPT 99606, the pharmacist must document the following information:

• Patient’s medical history and medication list
• Specific assessment and intervention provided during the session
• Date and duration of the face-to-face session
• Recommendations and advice given to the patient
• Progress made by the patient and any additional sessions scheduled
• Signature of the pharmacist providing the service

7. Billing guidelines

When billing for CPT 99606, ensure that the service is provided by a pharmacist to an established patient in a face-to-face setting for the initial 15 minutes. If additional time is spent with the patient, additional codes (such as 99607) should be used. It is important to follow the specific guidelines and requirements set by the payer when submitting claims for reimbursement.

8. Historical information

CPT 99606 was added to the Current Procedural Terminology system on January 1, 2008. There have been no updates or changes to the code since its addition.

9. Examples

1. A pharmacist providing a 15-minute medication therapy management session to an established patient, reviewing their medication list and suggesting strategies for improved compliance.
2. A pharmacist meeting with an established patient for a face-to-face session, assessing their medication needs and providing intervention to address any issues, all within 15 minutes.
3. A pharmacist conducting a medication therapy management session with an established patient, discussing potential drug interactions and providing recommendations for safer medication use, all within 15 minutes.
4. A pharmacist reviewing a patient’s medical history and medication list during a 15-minute face-to-face session, identifying potential medication-related problems and suggesting solutions.
5. A pharmacist meeting with an established patient for a medication therapy management session, assessing their medication adherence and providing education on proper medication use, all within 15 minutes.
6. A pharmacist conducting a face-to-face medication therapy management session with an established patient, discussing potential side effects and providing strategies for managing them, all within 15 minutes.
7. A pharmacist reviewing a patient’s medication list and medical history during a 15-minute medication therapy management session, identifying potential drug therapy problems and suggesting appropriate interventions.
8. A pharmacist meeting with an established patient for a face-to-face session, assessing their medication needs and providing recommendations for optimizing therapy, all within 15 minutes.
9. A pharmacist conducting a medication therapy management session with an established patient, discussing potential drug interactions and providing education on proper medication administration, all within 15 minutes.
10. A pharmacist reviewing a patient’s medical history and medication list during a 15-minute face-to-face session, identifying potential medication-related issues and suggesting appropriate interventions.