Advancing The Profession of Pharmacy

Billing for MTM Services Using “Incident-to” CPT Codes: Part 2

by | Jan 12, 2016 | MTM Entrepreneurship

In Part 1 of this series, we talked about a new opportunity for pharmacist-led clinical services in Chronic Care Management programs.

In this article, we will focus on the use of “incident-to” billing codes for MTM in conjunction with a physician visit.

Through the use of incident-to CPT billing codes, physicians can bill for pharmacist-led medication counselling sessions.  This practice is common in specialty practices, but is now trickling down into the family practice physician’s clinic.

The incident-to codes 99211-99215 allow for the physician to bill based on the complexity of the issue and the time spent with the patient.  Here is a link that explains the differences in time and complexity of the coding system.  This should be used as a guide for providing basic incident-to MTM counselling.

The American Academy of Family Physicians estimates that “only five 99211 encounters with Medicare patients in a week will result in over $5,000 per year for a practice”.

The basic guidelines for using these codes include: the patient must be established with the provider’s office, the encounter must be face-to-face and an E/M service must be provided separate from the physician encounter.  More information about benefits and good examples can be found in AAFP’s article which can be accessed here.
In Part 3 we will discuss how clinical pharmacists can offer pharmacogenomic testing as part of their service offerings.
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About the Author

Blair Thielemier, PharmD, is a business development consultant specializing in pharmacist-led billing models. She has set the industry standard for virtual pharmacy conferences with the Elevate Pharmacy Virtual Summit in 2017. She has consulted with national pharmacy organizations, drug wholesalers, point of sale companies, and Fortune 5 health insurers. She has books and online courses available for individuals looking to leverage their pharmacy knowledge into monetized clinical programs at She speaks internationally about trends in leveraging pharmacists to improve value-based care.


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