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Codes to let pharmacists bill for therapy management

Pharmacy Regulation Resource, July 13, 2005

Pharmacists will be able to bill third-party payers for medication therapy management services starting in 2006, the Pharmacist Services Technical Advisory Coalition said in a July 7 statement.

Billable services include providing education and training, monitoring medication compliance, modifying therapy, administering medication, formulating a treatment or follow-up plan, and managing medication problems, among other issues, the coalition said.

Pharmacists will be able to bill using the following codes beginning January 1, 2006:

• Code 0115T: A first-encounter service performed face to face with a patient up to 15 minutes at a time
• Code 0116T: For use with the same patient in a time increment of up to 15 minutes for a subsequent or follow-up encounter
• Code +0117T: Used to bill for additional increments of 15 minutes of time to either of the first two codes

The new codes will be in the latest online edition of the CPT manual. Visit www.ama-assn.org/ama/pub/category/3885.html to view the codes.

Pharmacists can also begin using a place of service (POS) code-POS Code 01-on October 1 for third-party billing and reporting forms to show that medication therapy management services took place in a pharmacy, the coalition said.

Tip: Document services provided to the patient, the coalition said. Depending on the service provided, pharmacists must be able to prove that they conducted a review of the patient's medication therapy, took a medical history, performed interventions, or communicated with the patient or caregiver.

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