For Dates of Service Before April 1, 2017

Intervention-Based Services-Procedure Codes and Modifiers

Claims submitted for intervention-based services must be submitted with one of the following CPT codes:

99605 — Medication therapy management service(s) provided by a pharmacist, individual, face-to-face with patient, with assessment and intervention if provided; initial 15 minutes, new patient.
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.
99607 — Medication therapy management service(s) provided by a pharmacist, individual, face-to-face with patient, with assessment and intervention if provided; each additional 15 minutes (list separately in addition to code for primary service).

Procedure codes submitted for intervention-based services must be submitted with one of the following modifiers:

U1 — Cost Effectiveness Intervention.
U2 — Three Month Supply Intervention.
U3 — Dose/Dosage form/Duration Change Intervention.
U4 — Focused Adherence Intervention.
U5 — Medication Addition Intervention.
U6 — Medication Deletion Interventions.
U7 — Medication Device Instruction Intervention.
U8 — In-home Medication Management Intervention.

Pharmacies should submit one procedure code and modifier per detail line. Claim details without the appropriate modifier will be denied.

CPT Code	Description
99605	Medication therapy management service(s) provided by a pharmacist, individual, face-to-face with patient, with assessment and intervention if provided; initial 15 minutes, new patient
99606	initial 15 minutes, established patient
99607	each additional 15 minutes (List separately in addition to code for primary service)

Intervention-Based Procedure Codes and Modifiers

Type of Intervention	Description	Modifier	CPT Code for New Patient	CPT Code for Established Patient	Reimbursement Rate	Payable for nursing home residents?	Limit
Cost-Effectiveness	Formulary interchange, therapeutic interchange, conversion to an over-the-counter product; tablet splitting opportunity; dose consolidation.	U1	99605 for first 15 minutes; 99607 for each additional 15 minutes	99606 for first 15 minutes; 99607 for each additional 15 minutes	$30	Yes	Unlimited
Three-Month Supply	Switching from one-month supply to three-month supply.	U2	99605 for first 15 minutes; 99607 for each additional 15 minutes	99606 for first 15 minutes; 99607 for each additional 15 minutes	$10	Yes	1/ drug/ rolling year
Dose/Dosage Form/Duration Change Intervention	Opportunity to change patient's dose, dosage form, or duration of therapy based on manufacturer recommended dose, organ function or age-appropriateness of dose; insufficient or excessive duration or quantity of medication prescribed; sub-optimal dosage form prescribed; drug-drug interaction or drug-food interaction.	U3	99605 for first 15 minutes; 99607 for each additional 15 minutes	99606 for first 15 minutes; 99607 for each additional 15 minutes	$30	Yes	4/member/ rolling year
Focused Adherence Intervention	Consultation with a patient regarding a significant lack of adherence in order to enhance the patient's understanding of his or her medication regimen.	U4	99605 for first 15 minutes; 99607 for each additional 15 minutes	99606 for first 15 minutes; 99607 for each additional 15 minutes	$30	No	4/member/ rolling year
Medication Additions Intervention	Adding a drug based on clinical concerns.	U5	99605 for first 15 minutes; 99607 for each additional 15 minutes	99606 for first 15 minutes; 99607 for each additional 15 minutes	$30	Yes	4/member/ rolling year
Medication Deletions Interventions	Deletion of a drug based on clinical concerns.	U6	99605 for first 15 minutes; 99607 for each additional 15 minutes	99606 for first 15 minutes; 99607 for each additional 15 minutes	$30	Yes	4/member/ rolling year
Medication Device Instruction Intervention	Intensive pharmacist consultation lasting more than five minutes on any device associated with a medication and subsequent patient or caregiver demonstration of the device's use.	U7	99605 for first 15 minutes; 99607 for each additional 15 minutes	99606 for first 15 minutes; 99607 for each additional 15 minutes	$30	No	4/member/ rolling year
In-Home Medication Management	Provided to assist members who, due to a physical or mental health condition, are not able to pick up their medication and do not have family members or friends who can pick up medication, or require device management. In-home medication management can only be reimbursed in conjunction with a focused adherence or medication device instruction, intervention-based service, or CMR/A.	U8	99605 for first 15 minutes; 99607 for each additional 15 minutes	99606 for first 15 minutes; 99607 for each additional 15 minutes	$10	No	4/member/ rolling year