CPT code 99606 – Medication therapy management

Key takeaways

CPT code 99606 bills the first 15 minutes of face-to-face medication therapy management a pharmacist provides to an established patient.

99606 is a primary code billed on its own. It does not need 99605 on the claim, and the two are never reported for the same session.

Add-on code 99607 covers each additional 15 minutes, so a 30-minute session is 99606 plus one unit of 99607.

Medicare Part D MTM is run by the plan sponsor, so rates are plan-negotiated rather than set by the Medicare Physician Fee Schedule.

Wrong patient status, 99607 billed without a primary code and missing start and stop times cause most 99606 denials.

CPT code 99606: Official descriptor and definition

CPT code 99606 is the medication therapy management (MTM) code for the first 15 minutes of a face-to-face pharmacist session with an established patient. It belongs to the American Medical Association’s CPT code set. The descriptor, as quoted by Utah Medicaid, reads as follows.

“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.”

Three elements decide when 99606 applies. The pharmacist meets the patient face to face, and the patient has already received an MTM service. The code then covers the first 15 minutes of assessment and any intervention. Some payers publish their own rule for new versus established status, so check the plan’s MTM policy.

• Code type: Primary code, billed on its own
• Patient status: Established patient
• Provider: Licensed pharmacist
• Setting: Face-to-face encounter
• Time unit: Initial 15 minutes
• Extra time: Add-on code 99607 for each additional 15 minutes

CPT 99606 vs 99605 vs 99607: How these MTM codes differ

The MTM CPT code family contains three codes. Two of them open a session, and the third extends it.

Patient status is the only difference between 99605 and 99606. All three descriptors specify face-to-face service, so none of them is a telephone code. CPT 99607 never stands alone, and the diagram below shows how it extends whichever initial code opened the session.

How to report 99607 with CPT 99606

CPT 99606 covers the first 15 minutes of the session. Each additional 15 minutes goes on the same claim as one unit of add-on code 99607. Because 99607 is an add-on, it is only reported alongside 99605 or 99606 for the same session.

1. Confirm patient status. Bill 99606 only for an established patient. A patient with no prior MTM service gets 99605 instead.
2. Report 99606 as the primary line. It needs no other MTM code on the claim, and 99605 never appears for the same session.
3. Calculate additional time. Subtract the first 15 minutes, covered by 99606, from total documented face-to-face time.
4. Convert the remaining time to units. Each full 15-minute block becomes one unit of 99607. Payers differ on partial blocks, so check the plan’s time rules before rounding up.
5. Document start and stop times. They are the evidence for every 99607 unit on the claim.

Payers also cap how many MTM sessions they pay for. Utah Medicaid fee-for-service, for example, allows one initial encounter and up to three follow-ups per member per calendar year. Those follow-ups are where 99606 is used.

Who can bill CPT code 99606?

Eligible providers for CPT code 99606 are licensed pharmacists delivering MTM services. Medicare does not recognize pharmacists as Part B billing providers for MTM. Most 99606 claims therefore flow through Medicare Part D plan MTM programs, Medicaid or commercial plans.

Provider status varies by state and payer. A growing number of states have granted pharmacists provider status under Medicaid or commercial plans, which opens direct billing pathways. Before submitting 99606 to any payer, confirm the following:

• Pharmacist licensure: The billing pharmacist must hold a current pharmacist license in the state where the service is delivered.
• MTM credentialing: Some Part D plans and MTM vendors require pharmacists to join their MTM network or complete an MTM certificate program.
• NPI enrollment: Many plans require the pharmacist’s individual NPI to be enrolled with the payer. A pharmacy NPI alone may not be accepted.
• State provider status laws: Scope-of-practice laws differ by state. Direct Medicaid billing under 99606 is available in some states but not others, so verify locally before billing.

How Medicare Part D and other payers cover CPT 99606

The Part D plan sponsor runs and funds the MTM program, so most pharmacists bill the plan for 99606 and never bill CMS. The sponsor contracts with pharmacists or MTM vendors, who submit claims to the plan or its MTM platform. That route differs from the Part B claim path in most explanations of how medical billing works.

CPT codes 99605, 99606 and 99607 are the standard codes used within Part D MTM programs. Reimbursement rates are negotiated between the plan and the MTM provider rather than set by the Medicare Physician Fee Schedule. Two pharmacists at different Part D plans may therefore receive different rates for the same 99606 service.

CPT code 99606 reimbursement rates

There is no single national rate for CPT code 99606. Part D plans negotiate MTM rates with pharmacists or MTM vendors, and Medicaid programs set their own fee schedules. Commercial plans pay a contracted rate where they recognize pharmacist billing. Check these points before you quote a rate:

• Part D plan rates are not publicly disclosed. Get them from your plan contract or MTM vendor agreement.
• Medicaid rates come from the state’s fee schedule and can change each year, so verify the current schedule before billing.
• Each 99607 unit is paid separately under the same contract, so the full rate for a longer session depends on both codes.
• Many commercial plans do not pay pharmacists for MTM at all. Run insurance eligibility verification before the session to confirm the plan covers it.

Documentation requirements for CPT code 99606

Documentation for CPT code 99606 must show the patient’s established status and the time spent face to face. Auditors and payer reviewers look for a small set of specific data points.

• Patient details and date of service: Required on every clinical note.
• Patient status: Note the date of the patient’s earlier MTM service, which supports billing 99606 rather than 99605.
• Pharmacist credentials: The note must identify the pharmacist by name, licensure (RPh, PharmD) and NPI.
• Start and stop times: Record the clock time the session began and ended. A note that says only “30-minute MTM session” leaves the 99607 unit open to denial on audit.
• Medications reviewed: List every medication covered, including over-the-counter products, supplements and herbals.
• Drug therapy problems identified: Document problems found, such as adherence issues, duplications, contraindications or adverse effects.
• Interventions and recommendations: Record each recommendation and whether the patient accepted or declined it.
• Written summary: Part D comprehensive medication reviews require a written summary in the CMS standardized format, including a medication action plan.
• Place of service (POS) code: Must match the setting where the session took place (see the place of service section below).

A clean claim submission for 99606 needs every one of these elements in place before the claim leaves the practice. Correcting documentation after a denial means an appeal, which delays payment.

Common denial reasons for CPT 99606 and how to avoid them

Most 99606 denials trace back to a short list of preventable errors. Proactive denial management workflows catch these issues before submission rather than after a rejection arrives. When a denial does arrive, the remittance explains it with a reason code from the standard list of medical billing denial codes.

The table below maps each common error to its fix.

Place of service and modifiers for CPT 99606

CPT 99606 needs no modifier for a standard in-person session. The place of service (POS) code must match where the session happened. Getting POS right early in revenue cycle management avoids adjudication failures later.

The 99606 descriptor specifies face-to-face contact. Some payers authorize MTM by telehealth. In that case, bill 99606 and any 99607 units as usual, with the POS code and modifier the payer’s policy names. Many payers use modifier 95 for synchronous audio-video visits, but confirm the policy in writing before submission.

Without that authorization, a remote session does not meet the descriptor. CPT 99607 is a time add-on, not a telephone code, so never swap codes to fit a remote session.

How Pabau reduces denials on CPT 99606 claims

Most 99606 denials start in the session note rather than on the claim. A missing stop time or the wrong patient status only surfaces once the payer rejects the line.

Pabau, the practice management and billing platform we build, lets pharmacists record each MTM session on a form. It holds fields for start time, stop time and medications reviewed. The note and the invoice sit on the same patient record. The biller can check patient status and minutes before choosing 99606 and the 99607 units.

Claims then go out through Claim.MD, Pabau’s US clearinghouse partner. Pabau creates the CMS-1500 claim from the invoice, runs real-time eligibility checks and tracks each claim to payment or denial. Remittances come back matched to their claims, and denied claims are flagged for rework. See how this works in Pabau’s claims management software.

Struggling with MTM claim denials?

Pabau keeps MTM session notes, invoices and Claim.MD claims on one patient record. Your 99606 and 99607 claims go out with the minutes and patient status payers check.

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Conclusion

The costly mistakes on CPT code 99606 come from treating it as an add-on. It is a primary code for an established patient’s first 15 minutes, and 99607 carries any extra time.

Settle patient status before the session is coded, and record start and stop times while the patient is still with you. Those two habits remove the denials that take longest to rework.

Book a demo to see how Pabau keeps MTM notes, invoices and claims together so 99606 claims go out right the first time.

Continue your research

Want to understand how clearinghouse submissions work for add-on codes? Medical claims clearinghouse guide explains how 837P files route add-on code pairs through Claim.MD to payers.

Need to reduce your denial rate across all CPT codes? Denial codes in medical billing covers CARC codes and corrective actions for the most common claim rejection types.

Looking for billing compliance guidance? Medical billing compliance outlines the documentation and audit readiness standards that support clean MTM claims.

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