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Chapter 10. Reimbursement for Pharmacist Services

Payment to the pharmacist for MTM services may come from all of the following EXCEPT

a. private payment (patient, family, caregivers)

b. health insurance

c. Medicare

d. MA-PD plans

e. PDPs

Answer c.

The CPT payment code for MTM-only services is

a. 99605

b. 99495

c. 99487

d. 99211

e. 99215

Answer a.

A superbill is

a. the same as 99606.

b. required by CMS for MTM billing.

c. required by PDPs for MTM payment.

d. useful for services beyond MTM.

e. required in transition care management

Answer d.

A requirement for CPT 99605 is

a. face-to-face interaction with the patient.

b. the patient’s goals for therapy.

c. a completed care plan.

d. a reduction in polypharmacy

e. improvement in patient outcomes

Answer a.

A requirement of incident to billing is

a. creation of the first care plan.

b. an extra payment for the primary provider.

c. done in the area where the care was delivered.

d. that the physician be physically present.

e. that adverse drug events must be reduced.

Answer c.

Transitional care management services that may be delegated include

a. collection and review of discharge information.

b. determination of need for follow-up activities.

c. interaction with other healthcare providers.

d. coordination of follow-up activities with other providers and services.


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