Basic terminology in obtaining reimbursement for pharmacists' cognitive services

Area of Science:

• Pharmacy Practice
• Healthcare Reimbursement
• Health Economics

Background:

• The pharmacy profession is increasingly seeking reimbursement for cognitive services.
• Barriers include payer misunderstanding of pharmacist roles and lack of appropriate billing codes.
• Pharmacy practitioners often lack detailed knowledge of reimbursement mechanisms and terminology.

Purpose of the Study:

• To provide a foundational understanding of essential billing and reimbursement terminology for pharmacists.
• To equip pharmacists with the knowledge needed to obtain reimbursement for cognitive services.
• To facilitate clearer communication between pharmacists and third-party payers.

Main Methods:

• Overview and definition of commonly used billing and reimbursement terms.
• Explanation of Current Procedural Terminology (CPT) codes for pharmacist services.
• Introduction to International Classification of Diseases (ICD-9/ICD-10) codes for diagnosis.

Main Results:

• Pharmacists can use CPT codes to describe patient care services.
• Since 2006, pharmacists can utilize ICD codes alongside CPT codes for billing.
• A glossary of terms and resources for web-based reimbursement information is provided.

Conclusions:

• Understanding billing and reimbursement terminology is vital for pharmacists to successfully obtain payment for cognitive services.
• Knowledge of these terms improves pharmacist communication with payers, Medicare, and Medicaid.
• This understanding helps address barriers to reimbursement and supports the expansion of pharmacist-provided patient care.