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99605
Quick jump to procedure code: Printer Friendly Version
99607

CPT® 99606: MEDICATION THERAPY MANAGEMENT SERVICE(S) PROVIDED BY A PHARMACIST, INDIVIDUAL, FACE-TO-FACE WITH PATIENT, WITH ASSESSMENT AND INTERVENTION IF PROVIDED; INITIAL 15 MINUTES, ESTABLISHED PATIENT

Short Description: Mtms by pharm est 15 min

--

CPT copyright 2015 American Medical Association. All rights reserved.


Medicare Reimbursement Information         Hide this section.

ALABAMA-Entire State
ALASKA-Entire State
ARIZONA-Entire State
ARKANSAS-Entire State
CALIFORNIA NORTH-Marin/Napa/Solano
CALIFORNIA NORTH-San Francisco
CALIFORNIA NORTH-San Mateo
CALIFORNIA NORTH-Oakland/Berkeley
CALIFORNIA NORTH-Santa Clara
CALIFORNIA NORTH-Rest of North California
CALIFORNIA SOUTH-Ventura
CALIFORNIA SOUTH-Los Angeles
CALIFORNIA SOUTH-Anaheim/Santa Ana
CALIFORNIA SOUTH-Rest of South California
COLORADO-Entire State
CONNECTICUT-Entire State
DELAWARE-Entire State
DIST of COL-DC + MD/VA Suburbs
FLORIDA-Ft Lauderdale
FLORIDA-Miami
FLORIDA-Rest of Florida
GEORGIA-Atlanta
GEORGIA-Rest of Georgia
HAWAII/GUAM-Entire State/Terr.
IDAHO-Entire State
ILLINOIS-East St. Louis
ILLINOIS-Suburban Chicago
ILLINOIS-Chicago
ILLINOIS-Rest of Illinois
INDIANA-Entire State
IOWA-Entire State
KANSAS-Entire State
KENTUCKY-Entire State
LOUISIANA-New Orleans
LOUISIANA-Rest of Louisiana
MAINE-Southern Maine
MAINE-Rest of Maine
MARYLAND-Baltimore and suburbs
MARYLAND-Rest of Maryland
MASSACHUSETTS-Boston
MASSACHUSETTS-Rest of Massachusetts
MICHIGAN-Detroit
MICHIGAN-Rest of Michigan
MINNESOTA-Entire State
MISSISSIPPI-Entire State
MISSOURI-Kansas City
MISSOURI-St. Louis
MISSOURI-Rest of Missouri
MONTANA-Entire State
NEBRASKA-Entire State
NEVADA-Entire State
NEW HAMPSHIRE-Entire State
NEW JERSEY-Northern NJ
NEW JERSEY-Rest of New Jersey
NEW MEXICO-Entire State
NEW YORK-Manhattan
NEW YORK-NYC Suburbs/LI
NEW YORK-Poughkpsie/No NYC Sub
NEW YORK-Rest of New York
NEW YORK-Queens
NORTH CAROLINA-Entire State
NORTH DAKOTA-Entire State
OHIO-Entire State
OKLAHOMA-Entire State
OREGON-Portland
OREGON-Rest of Oregon
PENNSYLVANIA-Philadelphia
PENNSYLVANIA-Rest of Pennsylvania
PUERTO RICO-Entire Territory
RHODE ISLAND-Entire State
SOUTH CAROLINA-Entire State
SOUTH DAKOTA-Entire State
TENNESSEE-Entire State
TEXAS-Brazoria
TEXAS-Dallas
TEXAS-Galveston
TEXAS-Houston
TEXAS-Beaumont
TEXAS-Fort Worth
TEXAS-Austin
TEXAS-Rest of Texas
UTAH-Entire State
VERMONT-Entire State
VIRGIN ISLANDS-Entire State
VIRGINIA-Entire State
WASHINGTON-Seattle (King County)
WASHINGTON-Rest of Washington
WEST VIRGINIA-Entire State
WISCONSIN-Entire State
WYOMING-Entire State


2016 OPPS Status Indicator: E

Effective April 1, 2013, and while sequestration is in effect, all CMS payments for services will be reduced by 2%. The fees above do not reflect this reduction. Click here for more information.

Commonly Associated Diagnosis Codes*            Hide this section.
Limited claims data available for this procedure.
PercentageICD-9ICD-10 Conversions
38.6% 427.31    Atrial fibrillation I48.91   Unspecified atrial fibrillation
9.1% 434.10    Cerebral embolism without cerebral infarction I66.09   Occlusion and stenosis of unspecified middle cerebral artery
OR:
I66.19   Occlusion and stenosis of unspecified anterior cerebral artery
OR:
I66.29   Occlusion and stenosis of unspecified posterior cerebral artery
OR:
I66.9   Occlusion and stenosis of unspecified cerebral artery
9.1% V58.61    Long-term (current) use of anticoagulants Z79.01   Long term (current) use of anticoagulants
6.8% V04.81    Need for prophylactic vaccination and inoculation, Influenza Z23   Encounter for immunization
4.5% 272.4    Other and unspecified hyperlipidemia E78.4   Other hyperlipidemia
OR:
E78.5   Hyperlipidemia, unspecified
4.5% 401.9    Unspecified hypertension I10   Essential (primary) hypertension
4.5% V58.69    Long-term (current) use of other medications Z79.891   Long term (current) use of opiate analgesic
OR:
Z79.899   Other long term (current) drug therapy
2.3% 794.8    Abnormal results of function studies, liver R94.5   Abnormal results of liver function studies
2.3% 682.3    Other cellulitis and abscess of upper arm and forearm L03.119   Cellulitis of unspecified part of limb
OR:
L03.129   Acute lymphangitis of unspecified part of limb
2.3% 625.9    Unspecified symptom associated with female genital organs N94.89   Other specified conditions associated with female genital organs and menstrual cycle
OR:
R10.2   Pelvic and perineal pain

* Commonly Associated ICD-10 codes derived from 2010 Physician Supplier Part B Medicare claims data and 2015 CMS General Equivalency Mapping Codes (GEM).
This data represents an analysis of 43 million claims processed for 1.7 million beneficiaries in 2010.

Medicare Coverage Policy Information         Hide this section.
No contractor selected.

99606 not found in an Local Coverage Determination (LCD) for your contractor. Other contractors covering 99606

CCI and MUE Edits*         Hide this section.

CCI Edits for 99606
Denied Codes (1)
Effective
Modifier
Accepted (2)
0405T Ovrsght xtrcorp liv asst pat
01/01/2016 No
90791 Psych diagnostic evaluation
01/01/2013 Yes
90792 Psych diag eval w/med srvcs
01/01/2013 Yes
90832 Psytx pt&/family 30 minutes
01/01/2013 Yes
90833 Psytx pt&/fam w/e&m 30 min
01/01/2013 Yes
90834 Psytx pt&/family 45 minutes
01/01/2013 Yes
90836 Psytx pt&/fam w/e&m 45 min
01/01/2013 Yes
90837 Psytx pt&/family 60 minutes
01/01/2013 Yes
90838 Psytx pt&/fam w/e&m 60 min
01/01/2013 Yes
90839 Psytx crisis initial 60 min
01/01/2013 Yes
90840 Psytx crisis ea addl 30 min
01/01/2013 Yes
90845 Psychoanalysis
01/01/2008 Yes
90846 Family psytx w/o patient
01/01/2008 Yes
90847 Family psytx w/patient
01/01/2008 Yes
90849 Multiple family group psytx
01/01/2008 Yes
90853 Group psychotherapy
01/01/2008 Yes
90865 Narcosynthesis
01/01/2008 Yes
90870 Electroconvulsive therapy
01/01/2008 Yes
92002 Eye exam new patient
01/01/2008 Yes
92004 Eye exam new patient
01/01/2008 Yes
92012 Eye exam establish patient
01/01/2008 Yes
92014 Eye exam&tx estab pt 1/>vst
01/01/2008 Yes
97001 Pt evaluation
01/01/2008 Yes
97002 Pt re-evaluation
01/01/2008 Yes
97003 Ot evaluation
01/01/2008 Yes
97004 Ot re-evaluation
01/01/2008 Yes
99201 Office/outpatient visit new
01/01/2008 Yes
99202 Office/outpatient visit new
01/01/2008 Yes
99203 Office/outpatient visit new
01/01/2008 Yes
99204 Office/outpatient visit new
01/01/2008 Yes
99205 Office/outpatient visit new
01/01/2008 Yes
99211 Office/outpatient visit est
01/01/2008 Yes
99212 Office/outpatient visit est
01/01/2008 Yes
99213 Office/outpatient visit est
01/01/2008 Yes
99214 Office/outpatient visit est
01/01/2008 Yes
99215 Office/outpatient visit est
01/01/2008 Yes
99217 Observation care discharge
01/01/2008 Yes
99218 Initial observation care
01/01/2008 Yes
99219 Initial observation care
01/01/2008 Yes
99220 Initial observation care
01/01/2008 Yes
99221 Initial hospital care
01/01/2008 Yes
99222 Initial hospital care
01/01/2008 Yes
99223 Initial hospital care
01/01/2008 Yes
99224 Subsequent observation care
01/01/2011 Yes
99225 Subsequent observation care
01/01/2011 Yes
99226 Subsequent observation care
01/01/2011 Yes
99231 Subsequent hospital care
01/01/2008 Yes
99232 Subsequent hospital care
01/01/2008 Yes
99233 Subsequent hospital care
01/01/2008 Yes
99234 Observ/hosp same date
01/01/2008 Yes
99235 Observ/hosp same date
01/01/2008 Yes
99236 Observ/hosp same date
01/01/2008 Yes
99238 Hospital discharge day
01/01/2008 Yes
99239 Hospital discharge day
01/01/2008 Yes
99281 Emergency dept visit
01/01/2008 Yes
99282 Emergency dept visit
01/01/2008 Yes
99283 Emergency dept visit
01/01/2008 Yes
99284 Emergency dept visit
01/01/2008 Yes
99285 Emergency dept visit
01/01/2008 Yes
99291 Critical care first hour
01/01/2008 Yes
99304 Nursing facility care init
01/01/2008 Yes
99305 Nursing facility care init
01/01/2008 Yes
99306 Nursing facility care init
01/01/2008 Yes
99307 Nursing fac care subseq
01/01/2008 Yes
99308 Nursing fac care subseq
01/01/2008 Yes
 
Denied Codes (1)
Effective
Modifier
Accepted (2)
99309 Nursing fac care subseq
01/01/2008 Yes
99310 Nursing fac care subseq
01/01/2008 Yes
99315 Nursing fac discharge day
01/01/2008 Yes
99316 Nursing fac discharge day
01/01/2008 Yes
99318 Annual nursing fac assessmnt
01/01/2008 Yes
99324 Domicil/r-home visit new pat
01/01/2008 Yes
99325 Domicil/r-home visit new pat
01/01/2008 Yes
99326 Domicil/r-home visit new pat
01/01/2008 Yes
99327 Domicil/r-home visit new pat
01/01/2008 Yes
99328 Domicil/r-home visit new pat
01/01/2008 Yes
99334 Domicil/r-home visit est pat
01/01/2008 Yes
99335 Domicil/r-home visit est pat
01/01/2008 Yes
99336 Domicil/r-home visit est pat
01/01/2008 Yes
99337 Domicil/r-home visit est pat
01/01/2008 Yes
99341 Home visit new patient
01/01/2008 Yes
99342 Home visit new patient
01/01/2008 Yes
99343 Home visit new patient
01/01/2008 Yes
99344 Home visit new patient
01/01/2008 Yes
99345 Home visit new patient
01/01/2008 Yes
99347 Home visit est patient
01/01/2008 Yes
99348 Home visit est patient
01/01/2008 Yes
99349 Home visit est patient
01/01/2008 Yes
99350 Home visit est patient
01/01/2008 Yes
99363 Anticoagulant mgmt initial
04/01/2016 Yes
99364 Anticoagulant mgmt subseq
04/01/2016 Yes
99455 Work related disability exam
01/01/2008 Yes
99456 Disability examination
01/01/2008 Yes
99460 Init nb em per day hosp
01/01/2009 Yes
99461 Init nb em per day non-fac
01/01/2009 Yes
99462 Sbsq nb em per day hosp
01/01/2009 Yes
99463 Same day nb discharge
01/01/2009 Yes
99465 Nb resuscitation
01/01/2009 Yes
99466 Ped crit care transport
01/01/2009 Yes
99468 Neonate crit care initial
01/01/2009 Yes
99469 Neonate crit care subsq
01/01/2009 Yes
99471 Ped critical care initial
01/01/2009 Yes
99472 Ped critical care subsq
01/01/2009 Yes
99475 Ped crit care age 2-5 init
01/01/2009 Yes
99476 Ped crit care age 2-5 subsq
01/01/2009 Yes
99477 Init day hosp neonate care
01/01/2008 Yes
99478 Ic lbw inf < 1500 gm subsq
01/01/2009 Yes
99479 Ic lbw inf 1500-2500 g subsq
01/01/2009 Yes
99480 Ic inf pbw 2501-5000 g subsq
01/01/2009 Yes
99485 Suprv interfacilty transport
01/01/2013 Yes
99486 Suprv interfac trnsport addl
01/01/2013 Yes
99487 Cmplx chron care w/o pt vsit
01/01/2013 No
99489 Cmplx chron care addl 30 min
01/01/2013 No
99490 Chron care mgmt srvc 20 min
01/01/2015 No
99495 Trans care mgmt 14 day disch
01/01/2013 No
99496 Trans care mgmt 7 day disch
01/01/2013 No
99497 Advncd care plan 30 min
01/01/2016 Yes
99605 Mtms by pharm np 15 min
01/01/2008 Yes
36591 Draw blood off venous device
10/01/2015 No
36592 Collect blood from picc
10/01/2015 No
G0250 Md inr test revie inter mgmt
04/01/2016 Yes
G0380 Lev 1 hosp type b ed visit
10/01/2008 Yes
G0381 Lev 2 hosp type b ed visit
10/01/2008 Yes
G0382 Lev 3 hosp type b ed visit
10/01/2008 Yes
G0383 Lev 4 hosp type b ed visit
10/01/2008 Yes
G0384 Lev 5 hosp type b ed visit
10/01/2008 Yes
G0410 Grp psych partial hosp 45-50
01/01/2010 Yes
G0411 Inter active grp psych parti
01/01/2010 Yes
G0459 Telehealth inpt pharm mgmt
10/01/2013 Yes
G0463 Hospital outpt clinic visit
07/01/2014 Yes
(1) These codes will be denied when submitted for payment on the same date of service as 99606.

(2) "Yes" indicates that the use of a modifier with the denied code will overcome the edit and allow payment.
"No" indicates that the second code will always be denied.


Medically Unlikely Edits for 99606


Practitioner
Hospital Outpatient
DME Supplier
Allowed Frequency per Day: 0 0 Not Listed
Adjudication Indicator: 3 Date of Service Edit: Clinical 3 Date of Service Edit: Clinical Not Listed
Rationale: CMS Policy CMS Policy Not Listed

* The responsibility for the content of any "National Correct Coding Policy" included in this product is with the Centers for Medicare and Medicaid Services and no endorsement by the AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, nonuse, or interpretation of information contained in this product.



   Medicare Part B Utilization Data for 99606*         Hide this section.


Annual Procedures / Tests Performed / Denied


Total National Services (all modifiers) Submitted 2015: 6,741
Total Services Denied 2015: 6,741 (100.0%)
National Charges Submitted 2015: $ 368,833.00
National Charges Allowed 2015: $ 0.00
National Average (No Modifier) Fee Submitted 2015: $ 54.72
National Average (No Modifier) Fee Allowed 2015: $ 0.00


Top 5 Performing Specialties 2015 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Internal medicine 2,588 38.4% $ 61.08 2,588 100.0%
Family practice 2,018 29.9% $ 42.29 2,018 100.0%
Cardiology 1,122 16.6% $ 23.67 1,122 100.0%
Geriatric medicine 480 7.1% $ 38.92 480 100.0%
General practice 167 2.5% $ 41.96 167 100.0%

Top 5 Places of Service 2015 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Office 6,201 92.0% $ 45.69 6,201 100.0%
Outpatient hospital 509 7.6% $165.67 509 100.0%
Independent laboratory 21 0.3% $ 13.76 21 100.0%
Skilled nursing facility 3 0.0% $155.00 3 100.0%
Inpatient hospital 3 0.0% $ 55.33 3 100.0%

Top 5 Modifiers Submitted 2015 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
No Modifier 6,665 98.9% $ 54.72 6,665 100.0%
59 - Distinct Procedural Service 58 0.9% $ 43.10 58 100.0%
GY 10 0.1% $ 88.30 10 100.0%
GW 2 0.0% $225.01 2 100.0%
GA - Advanced Beneficiary Notice (ABN) on File 2 0.0% $ 66.25 2 100.0%

Click here for more information on Custom CodeMap Medicare Utililation Reports.


*Utilization data is derived from analysis of the Physician Supplier Procedure Summary Master File (PSPSMF) which includes data from all Medicare Part B carriers. This data represents procedure-specific billing data for all physician/supplier services rendered to all Medicare beneficiaries during the calendar year named and processed by the Carriers through the six months of the following year.

Part B charge and utilization data for institutional services (hospital outpatient departments, home health agencies, comprehensive outpatient rehabilitation facilities, end-stage renal disease facilities, and rural health clinics) are processed by Medicare Part A fiscal intermediaries and are not included in this data. Data for services rendered to beneficiaries enrolled in risk-based Health Maintenance Organizations (HMOs) are also not included.

All information on this web site is compiled directly from information obtained from the Center for Medicare and Medicaid Services (CMS) and from its Contractors.

CodeMap® has made every reasonable effort to ensure the accuracy of the information contained on this web site. However, the ultimate responsibility for correct coding and claims submission lies with the provider of services. CodeMap® makes no representation, warranty, or guarantee that this compilation of Medicare information is error-free or that the use of this information will result in Medicare coverage and subsequent payment of claims. Final coverage and payment of claims are subject to many factors exclusively controlled by CMS and its contractors.

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12/09/2016 10:56:56 54.158.173.184

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