December 11, 2008
ASCP submits White Paper on Medication Therapy Management to Obama Transition Team
With input from ASCP members, ASCP Policy and Advocacy Department developed a white paper, entitled  “Medication-related Problems in Older Adults:  A Hidden and Costly Epidemic.”  This white paper has been submitted to Obama Transition Team staff.  Read the document by clicking on this link.

October 2008
ASCP Comments to CMS on HIPAA Electronic Transaction Standards for Billing Pharmacists' Professional Services
The Centers for Medicare & Medicaid Services (CMS) released a Notice of Proposed Rule Making (NPRM) on August 22, 2008 that proposed pharmacists' professional services be billed either via the NCPDP Telecommunication standard (the way medications are billed by pharmacies now) OR the X-12 standard (the way physicians and other health care professionals bill for their services). Previously, CMS said professional services could only be billed using X-12, so their August 22 proposal was a departure from their previous decision.

Using the NCPDP standard helps pharmacies who want to integrate billing medication therapy management services into their current work flow, but the X-12 standard must remain an option for those pharmacists who do not work in a pharmacy. ASCP cautiously agreed with CMS' proposal to use either standard, but ASCP urged CMS to adopt policies ensuring complete separation of product billing from service billing.

To view ASCP's comments, click here.  To view CMS' Proposed Rule on Electronic Transaction Standards, click here.

Contact Info:  MTM Contacts for Part D Plans

The Pharmacist Services Technical Advisory Coalition, of which ASCP is a member, has established a web site with information about billing for pharmacist services.  

Pharmacists have three nationally recognized codes to bill third-party payers for medication therapy management (MTM) services.  Current Procedural Terminology (CPT) codes 0115T, 0116T, and 0117T describe pharmacist-provided MTM services and recognize the initial face-to-face encounter, subsequent visits, and any appointment lasting beyond 15 minutes.  

Pharmacists who wish to submit claims for services must have a National Provider Identifier.  Please click here for information on how to obtain this NPI.

The Pharmacist Provider Coalition, of which ASCP is a member, advocates for payment for pharmacist services by Medicare Part B.

The Medicare Modernization Act of 2003 included a requirement that Medicare Part D sponsors provide a Medication Therapy Management Program as part of their Medicare drug benefit program offered to Medicare beneficiaries.  Please click here to access the text of this legislative requirement.

The regulations pertaining to Medication Therapy Management Services for Medicare Part D were issued by the Centers for Medicare and Medicaid Services and are very similar to the legislative language.  Please click here to view the regulations from the Federal Register.


ASCP Documents

ASCP released Practice Guidelines on medication therapy management services in long-term care in March 2007.

ASCP has a Briefing Room on Payment for Professional Pharmacist Services

ASCP and the American Pharmacists Association (APhA) have also developed a joint certificate program to educate pharmacists about MTM services.  Please click here for more details.


Other Documents

APhA led a coalition of eleven national pharmacy associations (including ASCP) to create a definition and program criteria for MTM Services, adopted in July 2004. 

APhA also commissioned a Lewin Report on MTM Services.

The Academy of Managed Care Pharmacists (AMCP) led a coalition of nine national organizations (including ASCP) in developing guidelines for Part D sponsors in creating MTM Programs.  This documentit titled, “Sound Medication Therapy Management Programs, a 2006 Consensus Document”.

AMCP and the American Society of Health-System Pharmacists jointly convened two executive sessions on medication therapy management services, in June and August of 2004.  Please click here for a summary of these sessions.

In September 2006, the Medicare Rights Center released an issue paper, Making Medicare Therapy Management a Cornerstone of Community-Based Care for People with Alzheimer's Disease and Other Forms of Dementia.  This paper recommends that Congress move toward providing MTM services under Medicare Part B.  Pleaase click here to access the issue paper.


More Resource Information is Available at:

Pharmacist.com MTM Resource Center

American Society of Health-System Pharmacists Resource Page on Medication Therapy Management Services

American Pharmacists Association Resource Page on Medication Therapy Management Services



Medicare Part D Medication Therapy Management Information

February 2007
AHRQ Report:  Survey of Medicare Part D Plans' Medication Therapy Management Programs

CMS Medicare Part D Prescription Drug Benefit Manual, Chapter 7:  Quality Improvement and Medication Therapy Management

Community MTM Services, Inc. is a subsidiary of the National Community Pharmacists Association and is also the provider of MTM services for Community Care Rx.

Humana, Information for Pharmacists about Medicare Part D Medication Therapy Management Program.

Outcomes Pharmaceutical Health Care is a national leader in the design, delivery, and administration of Medication Therapy Management programs. The company’s service line benefits health care purchasers by delivering a cost effective approach to advancing patient care and controlling utilization through the provision of patient-friendly, face-to-face personal pharmacist services.


Note:  To suggest additions for links to add to this page, send an e-mail to ASCP Government Affairs Associate Emory Rogers