Current procedural terminology codes for medication therapy management in administrative data

David R. Axon, Chanadda Chinthammit, Jared Tate, Ann M. Taylor, Sandra Leal, Matthew Pickering, Heather Black, Terri Warholak, Patrick J. Campbell

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: Three pharmacist-specific Current Procedural Terminology (CPT) codes exist to facilitate medication therapy management (MTM) reimbursement (codes 99605, 99606, and 99607). However, no studies have used CPT codes in administrative claims databases to identify subjects who have received MTM services. OBJECTIVE: To assess the prevalence of MTM services provided, using CPT codes identified in an administrative dataset. METHODS: A retrospective cohort study was conducted using a subset of Medicare Part D individuals from the IBM MarketScan Medicare Supplemental Research Databases (2009-2015). Researchers identified beneficiaries who received MTM services using CPT codes 99605, 99606, and 99607. RESULTS: Of the 16,483,709 individuals in the dataset, only 3,291 had CPT codes indicating that they received MTM services, representing an overall prevalence of 0.020%. CONCLUSIONS: The use of CPT codes as an indicator of MTM service provision resulted in far lower MTM utilization rates than in published literature. Reliance on CPT codes to identify MTM services in administrative claims is not recommended, given that it limited the researchers' ability to properly identify patient receipt of such services. More accurate methodologies are warranted for identifying MTM use and its effects on patient outcomes.

Original languageEnglish (US)
Pages (from-to)1297-1300
Number of pages4
JournalJournal of Managed Care and Specialty Pharmacy
Volume26
Issue number10
DOIs
StatePublished - Oct 2020

ASJC Scopus subject areas

  • Pharmacy
  • Pharmaceutical Science
  • Health Policy

Fingerprint

Dive into the research topics of 'Current procedural terminology codes for medication therapy management in administrative data'. Together they form a unique fingerprint.

Cite this