Using New CPT Codes Depends On Your Practice

Using New CPT Codes Depends On Your Practice Set-Up

New pharmacy medical billing codes have raised many questions in the medical world. The use of these new current procedural terminology codes depends on the set-up of your practice and how the pharmacy services are administered. Medical billing constantly changes and these new CPT codes are just one example of that statement.

There are three new medical billing codes for medication therapy management services. They are 0115T (Initial face-to-face assessment or intervention with the patient; 1-15 minutes, 0116T (Subsequent face to face assessment or intervention with the patient; 1-15 minutes, and 0117T (Each additional 15 minutes spent face-to-face with the patient; used in addition to 0115T or 0116T). As you can tell, these new medical billing codes are solely based on time. They are most practical when a pharmacist provides services in any place other then a clinic or an outpatient hospital setting.

The old set of current procedural terminology codes used for medical billing were based on evaluation and management visits. They were billed as incident to a physician’s visit. These codes included 99201 and 99211-99215. These medical billing codes can still be used, but they are used best when the services are provided in a clinic as incident to a physician visit.

Many people think payers will be quick to accept only the new CPT codes for medical billing, however currently there is missing information. The new medical billing codes do not include the relative value units (RVUs). There is no fee schedule in place for these new codes so it is currently solely up to the payer how much they choose to reimburse your practice. You can currently use the new medication therapy management service medical billing codes, but there are still some kinks in which to battle.

View all Articles by: Melissa Clark, CCS-P