Gavin Howe
Medication Therapy Management (MTM) is a service that optimizes therapeutic outcomes for patients. MTM services are provided by pharmacists or other qualified providers and include medication-related education, consultation, and advice to patients and their families. While MTM legal definitions and requirements have passed state legislation in several states, federal law supersedes state law, and CMS requirements for MTM services must be followed. CMS-approved MTM programs are required for Part D sponsors, and billing for MTM services typically requires claim processing through a registered pharmacy or provider's office.
| Characteristics | Values |
|---|---|
| Definition | Medication Therapy Management (MTM) is a distinct service or group of services that is intended to optimize the therapeutic outcomes of a patient. |
| Who can provide MTM services? | Pharmacists or other qualified providers. In some states, pharmacy interns can also provide MTM services under the direct supervision of a pharmacist. |
| States with MTM-specific legislation | Arizona, Idaho, Illinois, Indiana, Louisiana, Maine, New Hampshire, North Carolina, Ohio, Oregon, Tennessee, Vermont, West Virginia, and Wyoming. |
| Billing | MTM services are typically billed through an MTM contract with the Medicare Prescription Drug plan, and reimbursement is set by the Part D sponsor. Billing codes include 99605, 99606, and 99607. |
| Patient population | MTM is particularly effective for patients with multiple chronic conditions, complex medication therapies, high prescription costs, and multiple prescribers. |
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What You'll Learn
- MTM services are provided by pharmacists or other qualified providers
- MTM services are highly effective for patients with multiple chronic conditions
- MTM programs must ensure optimum therapeutic outcomes for targeted beneficiaries
- MTM CPT billing codes: 99605, 99606, and 99607
- MTM services are independent but can occur with medication provision
MTM services are provided by pharmacists or other qualified providers
Medication Therapy Management (MTM) services can be provided by pharmacists or other qualified providers. MTM services are highly effective for patients with multiple chronic conditions, complex medication therapies, high prescription costs, and multiple prescribers. MTM services offer medication-related education, consultation, and advice to patients, their families, and caregivers to ensure appropriate medication utilization. They also collaborate with the patient's interdisciplinary medical team to develop and optimize therapeutic outcomes.
MTM services can be provided independently by a pharmacist or in conjunction with the provision of a medication product. In some states, such as Ohio, a pharmacy intern can also provide MTM services under the direct supervision of a pharmacist. MTM services may be performed without a collaborative practice agreement and are independent of but can occur alongside the provision of a medication or medical device.
While MTM legal definitions and requirements have passed state legislation in several states, these laws cannot conflict with CMS Federal MTM requirements. CMS requirements include that MTM services are provided by a pharmacist or other qualified provider. Currently, under CMS, pharmacists do not have provider status, so Current Procedural Terminology (CPT) codes higher than Level 1 are typically not used. However, the scope of practice or specific payor may allow for higher levels.
For a pharmacist/provider to submit CPT codes for an MTM consultation, it must include a face-to-face or telehealth session, a review of patient history, and recommendations to improve medication outcomes and patient compliance. MTM services are currently billable through an MTM contract with the Medicare Prescription Drug plan, and reimbursement is set by the Part D sponsor. Billing for clinical services by pharmacists to a third-party payor typically requires claim processing through a registered pharmacy or provider's office.
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MTM services are highly effective for patients with multiple chronic conditions
Medication Therapy Management (MTM) is a service or group of services that aim to optimise therapeutic outcomes for patients. MTM services are highly effective for patients with multiple chronic conditions, as they can help to address medication-related issues and improve overall health outcomes.
MTM services are particularly beneficial for patients with multiple chronic conditions who take multiple prescription medications, over-the-counter drugs, herbal products, or dietary supplements. These services can help patients and their caregivers understand how to use their medications appropriately and ensure medication adherence. This is especially important for polypharmacy patients, who are at a higher risk of drug interactions or adverse events.
Through MTM services, pharmacists and providers can offer medication-related education, consultation, and advice. They can also collaborate with the patient's interdisciplinary medical team to develop and optimise treatment plans. MTM services can help improve medication utilisation, reduce medication-related problems, and enhance therapeutic outcomes.
MTM services are typically provided by pharmacists or other qualified providers. They may include medication therapy reviews, personal medication records, medication-related action plans, interventions, and referrals. These services can be offered independently or in conjunction with the provision of medication products, depending on the patient's needs and the scope of practice.
MTM services are covered by Medicare Part D for beneficiaries with two or more chronic conditions and high drug expenditures. However, there is a lack of comprehensive research on the comparative effectiveness of different MTM service models and patient engagement methods. More studies are needed to identify the optimal structures and processes for providing these services and directing them to the patients in greatest need.
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MTM programs must ensure optimum therapeutic outcomes for targeted beneficiaries
Medication Therapy Management (MTM) programs are intended to optimise therapeutic outcomes for patients. MTM services are distinct or can be a group of services that work towards improving a patient's health. MTM services can be provided independently by a pharmacist or pharmacy intern under the supervision of a pharmacist. They can also be provided in conjunction with the provision of a medication product or device. MTM services are highly effective for patients with multiple chronic conditions, complex medication therapies, high prescription costs, and multiple prescribers.
MTM services offer medication-related education, consultation, and advice to patients and their families. They also collaborate with the patient's interdisciplinary medical team to develop and optimise therapeutic outcomes. MTM services may be offered at different intensities, frequencies, or levels of integration with prescribers. MTM programs must ensure optimum therapeutic outcomes for targeted beneficiaries by providing interventions for both beneficiaries and prescribers. This includes an annual CMR with written summaries, as well as quarterly targeted medication reviews with follow-up interventions when necessary.
The CMS requires that each beneficiary enrolled in the MTM program be offered a minimum level of MTM services. This includes the annual CMR, which must include an interactive, person-to-person, or telehealth consultation performed by a pharmacist or other qualified provider, such as a nurse or physician. If a beneficiary is unable to accept the offer to participate in the annual CMR, the pharmacist or other qualified provider may perform the CMR with the beneficiary's prescriber, caregiver, or other authorised individual. MTM services are required for both community-dwelling beneficiaries and beneficiaries in long-term care settings. MTM program sponsors must enrol eligible Medicare Part D beneficiaries into the MTM program using an opt-out approach only.
MTM enrollees can refuse individual MTM services without having to disenrol from the MTM program. MTM program sponsors can also offer MTM services to beneficiaries who do not meet the CMS Part D criteria. MTM services may be offered through programs and modalities that do not rely on CMS reimbursement. For example, the Veterans Health Administration (VHA) includes MTM as one of several clinical activities provided to VHA health beneficiaries by VHA pharmacy services. MTM services provided by pharmacists may be billed through a contract with the Medicare Prescription Drug plan, and reimbursement is set by the Part D sponsor.
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MTM CPT billing codes: 99605, 99606, and 99607
Medication Therapy Management (MTM) is a service or group of services that are intended to optimise therapeutic outcomes for patients. MTM services are independent but can be offered in conjunction with the provision of medication. MTM services are highly effective for patients with multiple chronic conditions, complex medication therapies, high prescription costs, and multiple prescribers.
MTM CPT billing codes 99605, 99606, and 99607 are used to report the provision of medication therapy management services. These services are provided by a pharmacist to optimise the response to medications or manage treatment-related medication issues or complications. Code 99605 is used for the initial and more intensive encounter service, while 99606 is used for subsequent encounters with a focus on updating information, assessing patient compliance, and evaluating additional medications. Add-on code 99607 is used for each additional 15 minutes of service beyond the initial service.
The billing rates for these codes are determined by payers, who establish their own fee schedules. CPT Codes are a subcategory of HCPCS codes, and they are used to describe evaluation and management services provided to patients.
Under CMS regulations, pharmacists do not typically have provider status, so CPT codes higher than Level 1 are not commonly used. However, the scope of practice or specific payor may allow for higher levels. For a pharmacist/provider to submit CPT codes for an MTM consultation, it must include a face-to-face or telehealth session, a review of the patient's history, and recommendations to improve medication outcomes and patient compliance.
MTM services are currently billable through an MTM contract with the Medicare Prescription Drug plan, and reimbursement rates are set by the Part D sponsor. Billing for clinical services by pharmacists to a third-party payor usually requires claim processing through a registered pharmacy or provider's office.
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MTM services are independent but can occur with medication provision
Medication Therapy Management (MTM) services are independent of medication provision, but they can also occur in conjunction with it. MTM services are designed to optimise therapeutic outcomes for individual patients, and they can be provided by a pharmacist or a pharmacy intern under the direct supervision of a pharmacist. These services are particularly beneficial for patients with multiple chronic conditions, complex medication therapies, high prescription costs, and multiple prescribers.
MTM services involve medication-related education, consultation, and advice for patients and their families or caregivers. This helps ensure appropriate medication utilisation and collaboration with the patient's interdisciplinary medical team to optimise therapeutic outcomes. MTM services may also include coordinating and integrating medication therapy management within the patient's overall health management plan.
In terms of federal law, MTM services are currently not recognised as provider services under CMS, which means that pharmacists cannot submit CPT codes higher than Level 1. However, this may vary depending on the scope of practice or specific payor. MTM services are billable through a contract with the Medicare Prescription Drug Plan, and reimbursement rates are set by the Part D sponsor.
While MTM services are independent, they can be provided in conjunction with medication provision to achieve optimal therapeutic outcomes. This means that a pharmacist or qualified provider can offer MTM services while also dispensing medication to a patient. This integration ensures that patients receive comprehensive care and that their medication therapy is aligned with their overall health management goals.
It is important to note that MTM services are regulated at the state level, and currently, 14 states have passed specific legislation for MTM, including Arizona, Idaho, Illinois, Indiana, Louisiana, Maine, New Hampshire, North Carolina, Ohio, Oregon, Tennessee, Vermont, West Virginia, and Wyoming. These state laws must not conflict with the CMS Federal MTM requirements, and in the event of a conflict, the CMS requirements prevail.
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Frequently asked questions
Medication Therapy Management (MTM) is a distinct service or group of services that is intended to optimize the therapeutic outcomes of a patient. MTM can be an independent service provided by a pharmacist or pharmacy intern under the direct supervision of a pharmacist.
MTM services can be provided by a pharmacist or other qualified provider.
MTM services include medication-related education, consultation, and advice to patients, their families, and caregivers to help ensure appropriate medication utilization. MTM services also include collaborating with the patient's interdisciplinary medical team to develop and optimize therapeutic outcomes.
