Are the new CPT codes only for Part D MTM billing?
No. The MTM codes may be used by pharmacists in any situation where the described service is provided. Other CPT codes may be accepted by payers and depending on which CPT code being used, there may be restrictions with respect to how these specific codes may be used. It is advisable to contact a payer before using the code for the first time to make sure that they are configured to process the MTM codes. You should also inquire about any special handling requirements by the payer such as prior approval or submission to a particular person or department. PSTAC is extremely interested in hearing about your successful and unsuccessful experience with using the codes in various situations. Please forward any additional information via e-mail to PSTAC.
