Summary
Beginning March 1, 2024, pharmacists are enrolled as Provider Type 10 with Specialty 247, and the Provider Type 24 and Specialty 247 combination is closed. The Department added medication therapy management codes 99605, 99606 and 99607 and alcohol screening code 99408 for pharmacists, and added the PT 10 and Specialty 247 combination to existing services including vaccine administration, diabetic counseling, specimen collection and office visit codes. Non-specific vaccine administration codes 90471 and 90472 were end-dated.
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What to do
Action · 11 steps
01Already effective March 1, 2024: Pharmacists bill MA services for dates of service on and after that date under Provider Type 10 with Specialty 247.
02Codes end-dated for the Provider Type 24 and Specialty 247 combination after February 29, 2024 may be billed by pharmacists using the PT 10 and Specialty 247 combination: 90380, 90381, 90581, 90589, 90623, 90678, 90679, 90683, 90738, 90758, 91304, 91318, 91319, 91320, 91321 and 91322.
03Use the Pharmacists Covered Services Chart, Effective March 1, 2024, when billing for services pharmacists provide to MA beneficiaries.
04For medication therapy management, bill 99605 for the initial 15 minutes for a new patient, 99606 for the initial 15 minutes for an established patient, and 99607 on a second claim line for each additional 15 minutes.
05Keep the necessary documentation in the beneficiary's medical record.
06When a service or item exceeds MA Program Fee Schedule limits, submit a PE request on the MA 97 Outpatient Services Authorization Request Form through the 1150 Administrative Waiver Program Exception process.
07In fee-for-service, submit an 837 Professional or PROMISe Internet claim, because pharmacists may not use the standard NCPDP transaction for medical services.
08A pharmacist may be identified as the rendering and billing provider, or a pharmacist employed by or under contract with a hospital-based medical clinic, independent medical surgical clinic, pharmacy, or physician and physician group may assign the payment fee to the MA enrolled billing provider during enrollment.
09FQHCs and RHCs bill T1015 when a billable encounter includes MTM services, and on a separate claim line include the MTM procedure code with pricing modifier AT.
10These procedure code updates do not apply to pharmacist services provided in an FQHC or RHC.
11Pharmacists in the managed care delivery system should contact the appropriate MCO with coding or billing questions.
Codes mentioned
994089960599606996078303685610874008742687430876358763687804878118788095249952509525196372992029920399211992129921399407G0108G0109G0312G0315U000290471904729038090381905819058590587905899061190619906209062190622906239062590626906279063090632906339063690647906489065190656906629067090671906729067490675906779067890679906809068190682906839068590686906879068890691906969069790698907009070290707907109071390714907159071690717907239073290734907369073890739907439074490746907479074990750907569075890759913049131891319913209132191322G0008G0009T1015
Original notice
MAB2024021301
pa.gov · Always check the source before changing claims.
Related changes
See all Pennsylvania Medicaid (DHS) changes →MAB2024012401MediumNo effective date · Provider BulletinMAB2024042901MediumEffective Apr 29, 2024 · Provider BulletinMAB2023092901MediumEffective Oct 1, 2023 · Provider BulletinMAB2024090901HighEffective Sep 9, 2024 · Provider BulletinBrowse every Pennsylvania Medicaid (DHS) change in the policy list
Related policy hubs
Pennsylvania Medicaid (DHS) policiesPA policy changesPharmacyCode 99408Code 99605Code 99606Code 99607Code 83036Code 85610Code 87400Code 87426Code 87430Code 87635Code 87636Code 87804Code 87811Code 87880Code 95249Code 95250Code 95251Code 96372Code 99202Code 99203Code 99211Code 99212Code 99213Code 99407Code G0108Code G0109Code G0312Code G0315Code U0002Code 90471Code 90472Code 90380Code 90381Code 90581Code 90585Code 90587Code 90589Code 90611Code 90619Code 90620Code 90621Code 90622Code 90623Code 90625Code 90626Code 90627Code 90630Code 90632Code 90633Code 90636Code 90647Code 90648Code 90651Code 90656Code 90662Code 90670Code 90671Code 90672Code 90674Code 90675Code 90677Code 90678Code 90679Code 90680Code 90681Code 90682Code 90683Code 90685Code 90686Code 90687Code 90688Code 90691Code 90696Code 90697Code 90698Code 90700Code 90702Code 90707Code 90710Code 90713Code 90714Code 90715Code 90716Code 90717Code 90723Code 90732Code 90734Code 90736Code 90738Code 90739Code 90743Code 90744Code 90746Code 90747Code 90749Code 90750Code 90756Code 90758Code 90759Code 91304Code 91318Code 91319Code 91320Code 91321Code 91322Code G0008Code G0009Code T1015