The American Medical Association (AMA) Current Procedural Terminology (CPT) Editorial Panel has released a set of three codes for use by pharmacists in documentation and billing for medication therapy management services (MTMS) that are provided directly (face-to-face) to patients. The action comes following more than two years of collaboration and dialogue between the Pharmacist Services Technical Advisory Coalition (PSTAC) and the CPT Editorial Panel. The PSTAC, composed of eight national pharmacy associations, was established in 2002 to coordinate and advance the pharmacy profession's integration into the evolving environment of electronic data interchange, HIPAA-compliant coding standards, and professional services payment.
The codes are to be used to document and bill any health plan or third-party payer for MTMS covered by the plan:
Health plans and third-party payers will individually determine the payment rates and eligibility criteria for billing for the services. As an example, prescription drug plans (PDPs) that provide payment for MTM services within the Medicare Outpatient Drug Benefit (Part D) that becomes operational in January 2006, may choose to utilize the coding structure, depending on the structure and operation of their MTM programs.
As outlined in the descriptions of the services in the CPT manual, specific minimum parameters of documentation of the service should be met. These include review of patient history; medication profiles (prescription and non-prescription); interventions and recommendations; referrals; promoting treatment compliance; communications with other health care professionals; administrative functions (including patient and family communications) relative to a patient's care, and, as appropriate, scheduling of follow-up appointments.
The codes, released on July 1, 2005, are for use in complying with X12 837N standards for electronic health claims transactions as required by HIPAA regulations. They are currently approved as "Category III" codes, which according to AMA/CPT represent "...emerging technology, services, and procedures." The CPT Editorial Panel will review use of these codes over time in determining their eventual approval as Category I codes. The PSTAC encouraged the CPT Editorial Panel to approve the codes initially as Category I codes, and will continue its efforts to assure that the codes are eventually incorporated into Category I as more experience and data with the codes are gained.
Member organizations of PSTAC include the American College of Clinical Pharmacy, Academy of Managed Care Pharmacy, the American Pharmacists Association, the American Society of Consultant Pharmacists, the American Society of Health-System Pharmacists, the International Academy of Compounding Pharmacists, the National Association of Chain Drug Stores, and the National Community Pharmacists Association. Panel members representing the American College of Clinical Pharmacy on PSTAC are Dr. Magaly Rodriguez de Bittner of Baltimore, MD; Dr. Anna Garrett of Greensboro, NC; and Dr. Kathleen Snella of Amarillo, TX.
For further information, readers are encouraged to visit both the AMA/CPT information page (http://www.ama-assn.org/ama/pub/category/3885.html) and the PSTAC Web page (http://www.pstac.org/index.html).