Medical Coding for Medication Therapy Management (MTM) Services: Guidelines and Tips

Medication Therapy Management (MTM) services are patient-centred clinical services provided by pharmacists and other qualified healthcare professionals to optimize drug therapy and improve therapeutic outcomes. Accurate coding of MTM services is essential to ensure proper reimbursement and compliance with payer guidelines.

What Are Medication Therapy Management (MTM) Services?

MTM services involve comprehensive reviews of all medications a patient is taking, including prescription drugs, over-the-counter products, herbal supplements, and vitamins. These services aim to:

• Improve medication adherence

• Identify potential drug-drug and drug-disease interactions

• Prevent adverse drug events

• Optimize therapeutic outcomes

MTM is especially common for Medicare Part D beneficiaries and patients with multiple chronic conditions.

Common CPT® Codes for MTM Services

MTM services are primarily reported using the following CPT codes:

99605 – Initial MTM service provided by a pharmacist to a new patient, face-to-face, up to 15 minutes
99606 – Initial MTM service provided by a pharmacist to an established patient, face-to-face, up to 15 minutes
99607 – Each additional 15 minutes (add-on code used with 99605 or 99606)

These codes are time-based and require face-to-face interaction with the patient.

Tip: Always document the total time spent providing the MTM service to support the selected code.

Key Coding Guidelines for MTM Services

Face-to-Face Requirement

MTM CPT codes require direct, face-to-face interaction. Some payers may allow telehealth services, but this depends on payer-specific guidelines.

Time-Based Coding

Codes are based on time increments:

• First 15 minutes = 99605 or 99606

• Each additional 15 minutes = 99607

Do not round up time unless documentation supports it.

New vs. Established Patient

Select the correct code based on patient status:

• Use 99605 for new patients

• Use 99606 for established patients

Documentation Requirements

Strong documentation is critical to prevent denials. MTM documentation should include:

• Date of service

• Total time spent

• List of medications reviewed

• Identified medication-related problems

• Interventions performed

• Patient education provided

• Follow-up plan

Incomplete documentation is a common reason for denied claims.

Place of Service and Provider Requirements

MTM services are most commonly billed by licensed pharmacists. However, state laws and payer policies may vary. Check:

• State scope-of-practice rules

• Medicare Part D plan requirements

• Commercial payer guidelines

Use the correct Place of Service (POS) code depending on where services are provided (pharmacy, clinic, telehealth setting).

Place Of Service 

Common Coding Errors to Avoid

• Using MTM codes without documenting face-to-face time

• Billing 99607 without a primary code (99605 or 99606)

• Selecting the wrong new vs. established patient code

• Failing to follow payer-specific MTM requirements

Tips for Accurate MTM Coding

• Always verify payer coverage before billing

• Track time carefully during encounters

• Use standardized MTM documentation templates

• Keep up with payer and Medicare Part D updates

• Perform periodic internal audits to ensure compliance

Medication Therapy Management (MTM) Documentation Template

Patient Information

• Patient Name: ______________________________

• Date of Birth: ______________________________

• Medical Record Number (MRN): ________________

• Date of MTM Service: _________________________

• Pharmacist Name/Credentials: __________________

• Practice/Facility Name: _______________________

Type of MTM Service Provided

☐ Comprehensive Medication Review (CMR)
☐ Targeted Medication Review (TMR)
☐ Follow-up Visit
☐ Telephonic
☐ Telehealth / Virtual
☐ In-Person

Allergies / Adverse Drug Reactions

• Known Drug Allergies: ________________________

• Food/Environmental Allergies: _________________

• Previous Adverse Reactions: ___________________

Current Medication List

Include:
☐ Prescription medications
☐ OTC medications
☐ Herbal products
☐ Vitamins/Supplements

Medical Conditions / Diagnoses

• Chronic Conditions: __________________________

• Acute Conditions: _____________________________

• Relevant History: ______________________________

Medication Review Findings

☐ Duplicate therapy
☐ Drug–drug interactions
☐ Drug–disease interactions
☐ High-risk medications (e.g., Beers Criteria)
☐ Adherence issues
☐ Incorrect dosing
☐ Side effects reported

Details/Notes:

Assessment

Clinical Summary:

Overall Medication Safety:
☐ Safe and appropriate
☐ Needs monitoring
☐ Requires intervention

Care Plan / Interventions

Recommendations:

• ☐ Dose adjustment

• ☐ Medication change

• ☐ Discontinue medication

• ☐ Initiate new therapy

• ☐ Monitoring required

Provider Contacted:
☐ Yes ☐ No
Date/Time: ______________________

Patient Education Provided

Topics Covered:
☐ Proper medication use
☐ Side effects
☐ Storage and handling
☐ Adherence strategies
☐ Lifestyle modifications

Patient Understanding:
☐ Good ☐ Fair ☐ Poor

Follow-Up Plan

• Follow-up Required: ☐ Yes ☐ No

• Follow-up Date: ______________________________

• Method: ☐ Phone ☐ Telehealth ☐ In-Person

Pharmacist Attestation

I confirm that the MTM service was completed and documented accurately.

Pharmacist Signature: __________________________
Date: ________________________________________

Accurate coding of Medication Therapy Management services ensures proper reimbursement, supports compliance, and reflects the critical role these services play in improving patient safety and outcomes. Staying current with CPT guidelines and payer policies will help reduce denials and optimize revenue.

Medication Therapy Management