CPT code-change proposal: national data on pharmacists' medication therapy management services

Area of Science:

• Health Services Research
• Pharmacy Practice

Background:

• Medication Therapy Management (MTM) services are crucial for optimizing patient outcomes.
• Lack of standardized CPT codes hinders reporting and reimbursement for MTM services.

Purpose of the Study:

• To chronicle the historical efforts to establish CPT codes for MTM.
• To assess the progress of the Pharmacy and Therapeutics Administrative Committee (PSTAC) in securing codes.
• To present data from provider and payer surveys supporting a Category I CPT code proposal for MTM.

Main Methods:

• Historical review of CPT code development for MTM.
• Analysis of PSTAC's initiatives.
• Presentation of findings from national surveys of healthcare providers and payers.

Main Results:

• Progress has been made in advocating for CPT codes for MTM services.
• Survey data demonstrates support from providers and payers for a new MTM CPT code.
• A Category I CPT code-change proposal for MTM services was submitted.

Conclusions:

• Continued efforts are needed to finalize CPT codes for MTM.
• The submitted proposal, supported by survey data, represents a significant step toward enabling billing and reimbursement for MTM.
• Establishing these codes will facilitate broader access to and recognition of pharmacists' clinical services.