MedicaidCoverageMedium impact
Reimbursement for Pharmacists Administering Injections for STI
Maryland Medicaid·MD · Pharmacy, Infectious Disease·Provider Transmittal
Effective date
Jan 1, 2023
We identified it
Jun 20, 2026
Summary
Maryland Medicaid now reimburses pharmacists for administering injections for sexually transmitted infections and maintenance injectable medications, effective January 1, 2023. Pharmacists must meet specific licensure and enrollment requirements and bill using CPT 96372 at $15.35 per unit through provider type PH (Pharmacist Prescriber).
Action Required
Billing team must: (1) Ensure all pharmacist providers administering injectable STI or maintenance medications are enrolled in Maryland Medicaid as Pharmacist Prescribers via ePREP (eprep.health.maryland.gov); (2) Update billing system to recognize provider type PH for pharmacist claims; (3) Configure billing rules to bill CPT 96372 at $15.35 per unit with place of service code 01 (office); (4) Verify pharmacists meet COMAR 10.09.21, 10.67.06.04, and 10.34.41 requirements before processing claims; (5) Update CMS-1500 forms and encounter templates to reflect pharmacist injection administration services. Reference: https://health.maryland.gov/mmcp/provider/Pages/ffsclaims.html for billing instructions. Failure to enroll providers or use correct coding will result in claim denials.