How To Use CPT Code 99607

CPT 99607 describes the medication therapy management service provided by a pharmacist to a patient, with a face-to-face assessment and intervention if necessary. This article will cover the description, official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 99607?

CPT 99607 can be used to describe the medication therapy management service provided by a pharmacist to a patient. This service involves a face-to-face interaction where the pharmacist assesses the patient’s medication history, creates a medication profile, and provides recommendations to improve compliance and optimize medication outcomes. The code represents each additional 15 minutes of the session after the initial 15 minutes.

2. Official Description

The official description of CPT code 99607 is: ‘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).’ This code should be used in conjunction with CPT codes 99605 and 99606.

3. Procedure

1. The pharmacist meets the 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 optimize medication outcomes.
4. The pharmacist takes into account the patient’s medical conditions, complete list of medications, mental comprehension, and caregiver support.
5. The pharmacist provides advice to improve patient and caregiver understanding of the patient’s medication, with the goal of preventing adverse effects.
6. This code represents each additional 15 minutes of the session after the first 15 minutes.

4. Qualifying circumstances

CPT 99607 is applicable when a pharmacist provides medication therapy management services to a patient. The patient must be seen face-to-face, and the pharmacist must assess the patient’s medication history, create a medication profile, and provide recommendations for improving medication compliance and outcomes. The pharmacist takes into account the patient’s medical conditions, complete list of medications, mental comprehension, and caregiver support.

5. When to use CPT code 99607

CPT code 99607 should be used when a pharmacist provides medication therapy management services to a patient in a face-to-face setting. This code represents each additional 15 minutes of the session after the initial 15 minutes. It is important to note that CPT code 99607 should not be reported without an appropriate primary code for the initial 15 minutes, which can be either CPT code 99605 or 99606.

6. Documentation requirements

To support a claim for CPT code 99607, the pharmacist must document the following information:

• Patient’s medical history and medication list
• Medication profile created by the pharmacist
• Date, start and end time of the session
• Recommendations provided to improve medication compliance and outcomes
• Progress made by the patient and any additional sessions scheduled
• Signature of the pharmacist providing the service

7. Billing guidelines

When billing for CPT code 99607, ensure that the pharmacist provides the service in a face-to-face setting and that the session is documented appropriately. It is important to use the appropriate primary code (99605 or 99606) for the initial 15 minutes of the session. CPT code 99607 is an add-on code and should not be reported without an appropriate primary code. Pay attention to payer guidelines and modifiers when reporting this code.

8. Historical information

CPT code 99607 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 providing an additional 15 minutes of medication therapy management service to a patient with multiple chronic conditions.
2. A pharmacist conducting a face-to-face assessment and intervention for a patient with complex medication regimens, spending an additional 15 minutes to optimize medication outcomes.
3. A pharmacist reviewing a patient’s medication history and providing recommendations for improving medication compliance during an additional 15-minute session.
4. A pharmacist meeting with a patient’s caregiver to discuss medication management strategies and spending an additional 15 minutes on the session.
5. A pharmacist providing medication therapy management services to a patient with mental health conditions, spending an additional 15 minutes to address medication-related concerns.
6. A pharmacist conducting a medication review and providing education on potential drug interactions during an additional 15-minute session.
7. A pharmacist meeting with a patient to discuss medication adherence strategies and spending an additional 15 minutes on the session.
8. A pharmacist providing medication therapy management services to a patient with limited health literacy, spending an additional 15 minutes to ensure understanding of medication instructions.
9. A pharmacist conducting a comprehensive medication review and providing recommendations for optimizing medication therapy during an additional 15-minute session.
10. A pharmacist meeting with a patient to discuss potential side effects of medications and spending an additional 15 minutes on the session.