PNS114 Prevalence of Current Procedural Terminology (CPT) Codes for Medication Therapy Management (MTM) Services in Administrative Claims Data

D. Axon, C. Chinthammit, A.M. Taylor, J. Tate, S. Leal, M. Pickering, H. Black, T. Warholak, P. Campbell

Objectives

Three pharmacist-specific Current Procedural Terminology (CPT) codes exist to facilitate medication therapy management (MTM) reimbursement (codes 99605, 99606, 99607). Administrative claims databases contain a wealth of information however, no studies have utilized CPT codes to identify subjects who have received MTM services. The objective of this study was to assess the prevalence of MTM services provided, using CPT codes identified in an administrative dataset.

Methods

A retrospective cohort study was conducted using a subset of Medicare Part D beneficiaries from the Truven Health MarketScan® Medicare Supplemental Research Databases (2009-2015) included in the enrollment file. Researchers identified beneficiaries who received MTM services using CPT codes 99605, 99606, and/or 99607 any time between 2009 and 2015 from the inpatient and outpatient services files. The unique number of beneficiaries with at least one MTM CPT code was calculated. The prevalence of beneficiaries receiving MTM was estimated overall and by calendar year.

Results

Of the 16,483,709 beneficiaries in the dataset, only 3,291 had at least one of the three CPT codes related to receipt of MTM services. Based on these codes, the annual MTM prevalence estimates ranged from 0.003% (n=73) in 2009, increasing year after year to 0.098% (n=1586) in 2015; the overall prevalence was 0.020% during the study period.

Conclusions

This administrative database study, using CPT codes 99605, 99606, and 99607 as indicators of MTM service provision, resulted in a far lower prevalence than is reported in the published literature. Thus, reliance on CPT codes to identify MTM services in administrative claims is not recommended given the limited ability to properly identify beneficiaries’ receipt of such services. Future work is warranted to identify more accurate methodologies to identify MTM service utilization and assess its effects on patient outcomes.