Alexandria, Virginia – October 9, 2007
The pharmacy profession recently reached an important milestone by obtaining Category I status for the MTMS CPT codes. This is a major step forward that should expand pharmacists’ ability to provide valuable professional services for their patients.
The Current Procedural Terminology (CPT) codes are the nomenclature used by the health care industry for reporting professional services, laboratory tests, and medical procedures in health care claims. Each CPT code consists of a narrative description and an identifying code. In 2000, the CPT code set was designated in the Health Insurance Portability and Accountability Act (HIPAA) as the national coding standard for the health care industry. The American Medical Association (AMA) CPT Editorial Panel representing all specialties of medicine and allied health care professionals including pharmacists is in charge of developing CPT codes.
The Pharmacist Services Technical Advisory Coalition (PSTAC) applied and received approval for Medication Therapy Management Service (MTMS) codes in February 2005. The AMA assigned three (3) temporary codes that are being used exclusively by pharmacists in billing for MTMS. The three current MTMS CPT codes are 0115T, 0116T, and 0117T. These codes are deemed Category III codes, which mean they are temporary codes for emerging services, technology, and procedures. Category III codes are limited in duration—up to five years.
PSTAC submitted an application to the CPT Editorial Panel to change the MTMS CPT code status from temporary Category III to the permanent Category I classification. In preparing for the application, PSTAC funded a national survey of payors and providers to gather information pertaining to the widespread availability of medication therapy management services. Survey results indicated a total of 2.8 million face-to-face MTMS encounters between years 2004 and 2006.
Category I status was officially granted by the CPT Editorial Panel at its February 2007 meeting, thus establishing the MTMS codes as permanent codes. The MTMS codes have been reassigned new code numbers and are included in the recently-released edition of the CPT manual, CPT 2008. Pharmacists should keep in mind that the current MTMS CPT codes will continue to be used for the remainder of 2007. The new codes are effective January 1, 2008. The new codes, code descriptors, and accompanying text are:
Medication therapy management service(s) (MTMS) describe face-to-face patient assessment and intervention as appropriate, by a pharmacist, upon request. MTMS is provided to optimize the response to medications or to manage treatment-related medication interactions or complications.