Pharmacy recently reached an important milestone by being given Category I status for medication therapy management service (MTMS) CPT codes - a major step forward to support billing for professional services. The CPT (current procedural terminology) codes are the nomenclature used for reporting services, laboratory tests, and medical procedures on healthcare claims. Each CPT code includes a description for the use of the code. In 2000 the Health Insurance Portability and Accountability Act (HIPAA) named the CPT code set as the national coding standard for healthcare.

The American Medical Association (AMA) CPT editorial panel, which represents all specialties of medicine and allied healthcare professions, including pharmacists, is responsible for developing CPT codes. The Pharmacist Services Technical Advisory Coalition (PSTAC) was successful in gaining temporary status (Category III) codes in its original application. However, these have only a five-year time span. To gain permanent Category I status, PSTAC had to provide evidence of how widespread medication therapy management services were. A survey conducted found that there were 2.8 million face-to-face MTMS encounters between the years 2004 and 2006. With this evidence, Category I status was officially granted by the CPT editorial panel earlier this year, with new codes assigned that will go into effect on Jan. 1, 2008.

The new codes are for face-to-face patient assessments and interventions. MTMS includes the following documented elements: review of the pertinent patient history; medication profile of prescription and nonprescription drugs; and recommendations for improving health outcomes and treatment compliance. The new codes are not used to describe product-specific information at the point of dispensing or any other routine dispensing-related activities. The codes are:

99605    Medication therapy management services provided by a pharmacist  
              face-to-face with a patient, with assessment and intervention if
              provided; initial 15 minutes with new patient.   

99606    Initial 15 minutes with established patient.   

99607    Each additional 15 minutes that should be listed separately in
              addition to the code for the primary service.   

PSTAC is a coalition of seven national pharmacy organizations: the American College of Clinical Pharmacy (ACCP); the Academy of Managed Care Pharmacy (AMCP); the American Pharmacists Association (APhA); the American Society of Consultant Pharmacists (ASCP); the American Society of Health-System Pharmacists (ASHP); the National Association of Chain Drug Stores (NACDS); and the National Community Pharmacists Association (NCPA). The coalition has been successful in integrating pharmacists and their professional services into the traditional medical services billing model and providing the leadership to secure pharmacy's position in the national electronic data interchange of encounters/ claims and payment of professional services. For more information about PSTAC and the MTMS codes, go to www.pstac.org.