Current Procedural Terminology Codes for Medication Therapy Management in Administrative Data.

Area of Science:

• Health Services Research
• Pharmacy Practice
• Health Economics

Background:

• Three pharmacist-specific Current Procedural Terminology (CPT) codes exist for medication therapy management (MTM) reimbursement.
• No prior studies have utilized these CPT codes in administrative claims databases to identify MTM service recipients.

Purpose of the Study:

• To determine the prevalence of MTM services provided by pharmacists.
• To assess the utility of CPT codes in identifying MTM service delivery within administrative datasets.

Main Methods:

• A retrospective cohort study analyzed Medicare Part D beneficiaries from 2009-2015.
• MTM services were identified using CPT codes 99605, 99606, and 99607.

Main Results:

• Out of over 16 million individuals, only 3,291 (0.02%) received services coded as MTM.
• This indicates a significantly lower utilization rate than previously reported in literature.

Conclusions:

• CPT codes alone are inadequate for accurately identifying MTM service provision in administrative claims.
• Current methods limit the ability to ascertain patient receipt of MTM services.
• Development of more precise methodologies is crucial for evaluating MTM utilization and impact.