MedicaidBilling CodesHigh impact
Maryland Medicaid Reimbursement for Services Provided by Pharmacists within Their Lawful Scope of Practice, Effective January 1, 2024
Maryland Medicaid·MD · Pharmacy·Provider Transmittal
Effective date
Jan 1, 2024
We identified it
Jun 20, 2026
Summary
Effective January 1, 2024, Maryland Medicaid now reimburses pharmacists for smoking cessation counseling and medication therapy management (MTM) services within their lawful scope of practice. Pharmacists must enroll as PH - Pharmacist Prescriber providers and bill using new CPT codes (99406, 99407, 99605, 99606, 99607) with specific payment rates established for both FFS and MCO plans.
Action Required
By December 31, 2023: (1) Billing team must update billing system to recognize and properly code new pharmacist services using CPT codes 99406, 99407, 99605, 99606, and 99607 with correct reimbursement rates effective January 1, 2024. (2) Verify all rendering pharmacists are enrolled in Maryland Medicaid via ePREP as provider type PH - Pharmacist Prescriber and that the pharmacy group is set up as the billing provider. (3) Update billing software to ensure pharmacist group submissions include applications for both the group and individual rendering pharmacists. (4) Configure claims to reflect the new fee schedule: 99406 ($16.65), 99407 ($30.60), 99605 ($49.67), 99606 ($31.24), 99607 ($24.54). (5) Train billing and provider staff on new service codes and documentation requirements. Contact ePREP Call Center (1-844-463-7768) if enrollment issues arise. Claims submitted without proper pharmacist enrollment or using incorrect codes will be denied.