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Ohio News: BCMH Announces Two New MTMS Opportunities
Published in the February 2006 Ohio State Board of Pharmacy Newsletter
Pharmacists may be interested in the following two announcements received in the Board office from the Bureau for Children with Medical Handicaps (BCMH):
Pediatric Asthma: Pharmacists who are providers to the BCMH, Ohio Department of Health, may use the following current procedural terminology codes to bill for Medication Therapy Management Services (MTMS) provided to eligible children with severe pediatric asthma. The pharmacist must be working collaboratively with a Pediatric Pulmonologist, or receiving a referral, to perform the MTMS.
The codes are American Medical Association (AMA)-approved codes. MTMS describes face-to-face patient assessment, and intervention as appropriate, by a pharmacist. MTMS is provided to optimize the response to medications or to manage treatment-related medication interactions or complications.
MTMS includes the following documented elements: review of the pertinent patient history, medication profile (prescription and non-prescription), and recommendations for improving health outcomes and treatment compliance. These codes are not to be used to describe the provision of product-specific information at the point of dispensing or any other routine dispensing-related activities.
The code descriptions, numbers, and compensation levels are as follows:
- 0115T – [MTMS] provided by a pharmacist, individual, face-to-face with patient, initial 15 minutes, with assessment, and intervention if provided; initial encounter. Compensation level: $52.57.
- 0116T – Subsequent encounter. Compensation level: $34.35.
- 0117T – each additional 15 minutes. This code is to be listed separately in addition to code for the primary service. Use of the 0117T code is in conjunction with the 0115T or 0116T codes. Compensation level: $24.74.
These codes are effective immediately and can be used by BCMH pharmacist providers for BCMH-eligible recipients with asthma.
Pediatric Diabetes: The BCMH, Ohio Department of Health, will be extending MTMS to children with coverage to include those with diabetes.
Pharmacists who are providers to BCMH will also be able to utilize MTMS codes when providing services to these patients. Previously the Bureau announced a similar action for children with severe pediatric asthma. The pharmacist must have a referral from the managing pediatric endocrinologist and be working collaboratively with that physician.
The same CPT codes recently approved by the AMA are applicable for billing purposes for this set of patients. MTMS describes face-to-face patient assessment, and intervention as appropriate, by a pharmacist. MTMS is provided to optimize the response to medications or to manage treatment-related medication interactions or complications.
MTMS includes the following documented elements: review of the pertinent patient history, medication profile (prescription and non-prescription), and recommendations for improving health outcomes and treatment compliance.
These codes are not to be used to describe the provision of product-specific information at the point of dispensing or any other routine dispensing-related activities. The codes are effective immediately and can be used by BCMH pharmacist providers for BCMH-eligible recipients with diabetes as well as asthma.
