Medication Therapy Management (MTM)

As of January 1, 2006, Medicare beneficiaries gained access to an outpatient prescription drug benefit established by Congress as part of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA). Known as Medicare Part D, the benefit is administered through stand-alone prescription drug plans (PDP) and Medicare Advantage prescription drug plans (MA-PD). Required under MMA as part of the Medicare Prescription Drug Benefit, Medication Therapy Management (MTM) is about enhancing safe, effective, appropriate, and economic use of medications. Importantly, MTM is about the patient rather than simply focusing on dispensing the medications. MTM represents the first nationwide opportunity for payment of patient care services delivered by pharmacists. MTM is a set of distinct services where pharmacists review and help manage the patient's drug therapies in relation to the patient's health and disease conditions. The services may include: patient education, drug regimen review, problem intervention, physical assessment, adherence and persistence counseling, provision of medication action plans and personal medication records, disease management. However, MTM is not dispensing-related services, providing medication leaflets, or physician services.

Using the CMS Form 1500, the 2008 updated/permanent Current Procedural Terminology (CPT) Codes authorized for billing MTM services are:
99605 Medication therapy management service(s) provided by a pharmacist, individual, face-to-face with patient, initial 15 minutes, with assessment, and intervention if provided; initial 15 minutes, new patient
99606 initial 15 minutes, established patient
99607 each additional 15 minutes (List separately in addition to code for the primary service) (Use 99607 in conjunction with 99605, 99606)

For more information, click here: CPT codes.

The Centers for Medicare and Medicaid Services (CMS) indicates that MTM must evolve and become a cornerstone of the Medicare Prescription Drug Benefit. Various health professions have significant interest in participating in MTM programs and services. And with the design of MTM programs loosely defined by CMS, clarification of how MTM programs are structured will provide a better understanding of MTM and help guide interested health professionals in furthering the endeavor.