2025 CPT code 99605
(Active) Effective Date: N/A Revision Date: N/A Medicine - Medication Therapy Management Services Medicine Services and Procedures Feed
Medication therapy management service (MTMS) provided by a pharmacist, face-to-face with a new patient; initial 15 minutes.
Modifiers may be applicable to 99605 depending on the circumstances of service. Consult the CPT manual for details.
Medical necessity for 99605 is established when a patient has complex medication regimens, significant risk factors for medication errors or adverse drug events, or when the patient needs education and counseling to optimize their medication therapy.
The pharmacist conducts a face-to-face assessment of the new patient, reviews their medical history and medication list, creates a medication profile, and provides recommendations for optimal medication use and adherence. The pharmacist addresses issues such as medication interactions, potential side effects, and strategies for improved patient understanding and compliance.
In simple words: The pharmacist spends 15 minutes with a new patient, reviewing their medical history and medications to help them take their medicine correctly and get the best results.They give advice to prevent problems.
This CPT code, 99605, represents a medication therapy management service (MTMS) furnished by a pharmacist to a new patient.The service involves a face-to-face encounter lasting 15 minutes, including a patient assessment and intervention as deemed appropriate.The pharmacist reviews the patient's pertinent history, medication profile (including prescription and nonprescription medications), and makes recommendations to improve health outcomes and treatment compliance.This code is not to be used for product-specific information at the point of dispensing or for routine dispensing activities.
Example 1: A 70-year-old patient with multiple chronic conditions (diabetes, hypertension, hyperlipidemia) starts a new medication regimen. The pharmacist conducts a 99605 visit to review the new medications, their potential interactions with existing medications, and provide education on proper administration and potential side effects., A patient newly diagnosed with asthma initiates an inhaled corticosteroid. The pharmacist performs a 99605 visit to ensure the patient understands how to use the inhaler correctly, to address any concerns, and provide counseling on managing asthma symptoms., A patient recently discharged from the hospital is prescribed multiple new medications for heart failure. The pharmacist uses a 99605 visit to reconcile medications, address potential drug interactions, and provide education on managing their heart failure.
* Patient's medical history (including diagnoses, allergies, and other relevant medical information).* Complete medication list (prescription and over-the-counter medications, herbal remedies, supplements).* Documentation of the face-to-face encounter, including time spent, topics discussed, and recommendations made by the pharmacist.* Evidence of patient understanding and agreement regarding the plan of care.
** The duration of the service is limited to the initial 15 minutes.Additional time should be billed using CPT code 99607.These services are typically provided by a pharmacist in an outpatient setting.
- Revenue Code: M5D (SPECIALIST - OTHER)
- RVU: This information requires access to a specific payer's fee schedule and may vary based on geographic location and other factors.RVUs are not explicitly provided in the source data.
- Global Days: This code does not have a global period.
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Fee Schedule: Historical fee schedule data is not included in the source data. This information varies by payer and location.
- Specialties:Pharmacists, Pharmacy
- Place of Service:Office, Pharmacy, Other Place of Service (depending on the pharmacist's practice setting)