2025 CPT code 99607
(Active) Effective Date: N/A Medicine - Medication Therapy Management Services Feed
Medication therapy management service provided by a pharmacist, face-to-face with the patient, including assessment and intervention if provided; each additional 15 minutes (List separately in addition to code for primary service).
Medical necessity for MTM services must be established and documented. This could include polypharmacy, complex medication regimens, recent hospitalizations or transitions of care, medication non-adherence, or the need for education about new medications or changes to existing medication therapy.The documentation should support the clinical rationale for the service and the need for the extended time represented by 99607.
The pharmacist conducts a face-to-face visit with the patient, reviewing their medical history and medication list. The pharmacist develops a medication profile and provides recommendations to improve the patient's medication adherence and achieve optimal therapeutic outcomes. This involves considering the patient's medical conditions, all medications they take, their cognitive abilities, and caregiver support. The pharmacist educates both the patient and caregiver about the medications, aiming to prevent adverse drug events and optimize medication use.
In simple words: For every 15 minutes beyond the first 15 minutes a pharmacist spends with you in person to discuss your medications and health, this code is used.The pharmacist will look at your medical history, all the medications you take (including over-the-counter ones), and provide recommendations to improve your health and help you take your medications as prescribed.
This code describes an additional 15-minute increment of medication therapy management (MTM) service provided by a pharmacist in a face-to-face setting with a patient.The service includes assessment and intervention as needed.It encompasses reviewing the patient's history, medication profile (both prescription and non-prescription), and making recommendations to improve health outcomes and medication compliance. This code must be used in conjunction with the appropriate primary code (99605 for new patients or 99606 for established patients) for the initial 15 minutes of service. It is not intended for product-specific counseling at the time of dispensing or other routine dispensing activities.
Example 1: A patient with newly diagnosed diabetes is referred for MTM services.The initial 15 minutes (99605) are used to gather information and develop a care plan.The pharmacist then spends an additional 30 minutes (two units of 99607) educating the patient on insulin administration, blood glucose monitoring, and lifestyle modifications., A patient taking multiple medications for chronic conditions sees their pharmacist for their annual MTM review. The initial 15 minutes (99606) cover medication reconciliation and assessment. An additional 15 minutes (one unit of 99607) is spent discussing potential drug interactions and side effects., A patient recently discharged from the hospital is referred for MTM to ensure they understand their new medication regimen. Following the initial 15-minute visit (99606), the pharmacist spends an additional 45 minutes (three units of 99607) working with the patient and their caregiver to develop a medication management plan, address adherence challenges, and answer questions.
Documentation for each MTM service must include the date of service, patient's name and date of birth, a comprehensive medication list, relevant medical history, the pharmacist's assessment, interventions provided, recommendations for improving medication therapy, and any patient education provided.If add-on code 99607 is used, the total time spent and medical necessity of the extended session should also be documented.
- Payment Status: Active
- Specialties:Pharmacists
- Place of Service:Office, Inpatient Hospital, On Campus-Outpatient Hospital, Federally Qualified Health Center, Public Health Clinic, Rural Health Clinic, Independent Clinic, Nursing Facility, Telehealth Provided in Patient’s Home, and other places of service as appropriate.