APhA Policy Manual

Billing and Documentation of Medication Therapy Management (MTM) Services

PHARMACEUTICAL CARE PHARMACY PRACTICE RECORD SYSTEMS REIMBURSEMENT AND COMPENSATION

APhA encourages the development and use of a system for billing of medication therapy management (MTM) services that: (a) includes a standardized data set for transmission of billing claims, (b) utilizes a standardized process that is consistent with claim billing by other health care providers, and (c) utilizes a billing platform that is accepted by the Centers for Medicare and Medicaid Services (CMS) and is compliant with the Health Insurance Portability and Accountability Act (HIPAA).
APhA supports the pharmacist’s or pharmacy’s choice of a documentation system that allows for transmission of any MTM billing claim and interfaces with the billing platform used by the insurer or payer.
APhA encourages pharmacists to use the American Medical Association (AMA) Current Procedural Terminology (CPT) codes for billing of MTM services.
APhA supports efforts to further develop CPT codes for billing of pharmacists’ services, through the work of the Pharmacist Services Technical Advisory Coalition (PSTAC) and Pharmacy e-HIT Collaborative.