CPT 99605: Pharmacist 15-Minute Medication Evaluation for New Patient
Headline: CPT code 99605: Pharmacist 15‑Minute Medication Evaluation for New Patients
Lead: CPT code 99605 defines a 15‑minute, in‑person, patient‑specific medication evaluation performed by a pharmacist for a new patient. The code captures a focused pharmacist encounter that reviews the patient’s history and medication list to identify drug‑therapy problems and guide individualized recommendations. Nationally, recognition of pharmacist‑led medication evaluations supports care coordination, medication safety, and chronic disease management across outpatient settings.
This publication covers how CPT code 99605 is used and why it matters to payers and providers. Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical service captured by the code, what typical sites of service look like, and the elements that define the billed encounter. The analysis summarizes common modifiers and payer considerations when billing pharmacist‑provided medication evaluation services, highlights relevant billing practice implications, and outlines where data was unavailable.
What readers will learn: benchmarks and billing patterns for pharmacist medication evaluations, common modifier usage and payer recognition, clinical context for integrating this service into outpatient care, and limitations where input data was not provided. The content is designed for national audiences of billing professionals, pharmacists, and payer policy staff seeking a clear, concise reference for CPT code 99605.
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Billing Code Overview
CPT code 99605 describes a 15–minute, in–person, patient‑specific medication evaluation provided by a pharmacist for a new patient. The service centers on review of the patient’s history and medication list to assess medication therapy, identify therapy problems, and develop recommendations tailored to the individual patient.
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Service type: Pharmacist medication therapy management / medication evaluation for a new patient
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Typical site of service: Ambulatory clinic, outpatient pharmacy consultation area, or other in‑person outpatient setting
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 67-year-old patient with multiple chronic conditions (type 2 diabetes, hypertension, and recent hospital discharge for heart failure) presents to a community pharmacy clinic for an initial, in-person medication therapy management visit. The pharmacist reviews the patient’s complete medication list, medical history, recent hospital discharge summary, laboratory results, and current symptoms. The 15-minute encounter focuses on identifying drug-drug interactions, dosage appropriateness, adherence barriers, and opportunities to simplify therapy. The pharmacist documents a patient-specific medication evaluation, provides education, reconciles medications with the discharge list, and communicates recommendations to the primary care provider. The service is billed as a single, face-to-face pharmacist encounter designated for a new patient medication evaluation under 99605 and takes place in a clinic-based or community pharmacy consultation room. The workflow includes appointment scheduling, pre-visit chart review, focused patient interview and reconciliation during the 15-minute visit, documentation in the medical record, and secure transmission of findings to the treating clinician.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Default/No modifier specified | Use when no additional modifier applies to the billed service. |
22 | Increased procedural services | Use when the pharmacist documents substantially greater work than typical for a 15-minute evaluation. |
52 | Reduced services | Use when the service provided was partially reduced or eliminated at the patient’s request or clinical decision. |
53 | Discontinued procedure | Use when the encounter was started but discontinued due to patient instability or other clinical reasons. |
59 | Distinct procedural service | Use when this medication evaluation is distinct and separate from another non-overlapping service on the same day. |
95 | Synchronous telemedicine service rendered via real-time interactive audio and video | Use only if the service is provided via live telehealth technology (note: 99605 describes in-person; use of 95 implies telehealth adaptation per payer rules). |
93 | Patient is eligible for services under a clinic or site-specific program (payer-specific) | Use when payer-specific program coding requires this modifier — follow payer guidance. |
55 | Split (or shared) E/M service by different clinicians | Use when a shared visit occurs and documentation supports split/shared billing according to payer policy. |
CG | Service provided under a Medicare Part B comprehensive primary care plus model (placeholder) | Use only if applicable under specific program reporting requirements per payer. |
PO | Service furnished pursuant to a non-physician practitioner’s organizational protocols (payer-specific) | Use when organizational protocol or payer requires this modifier for pharmacist-provided services. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
183500000X | Clinical Pharmacist | Pharmacist providing medication therapy management and patient-specific evaluations. |
333600000X | Family Medicine | Primary care physicians coordinating care and receiving pharmacist recommendations. |
207Q00000X | Internal Medicine | Physicians treating complex chronic disease who collaborate with pharmacists on medication optimization. |
261QM0800X | Nurse Practitioner | Advanced practice providers who may refer patients for pharmacist consultation. |
207L00000X | Cardiology | Specialists commonly involved when medication-related issues affect cardiovascular therapy. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
E11.9 | Type 2 diabetes mellitus without complications | Common chronic condition requiring complex medication regimens and frequent medication review. |
I10 | Essential (primary) hypertension | Frequently present in patients on multiple antihypertensive agents requiring reconciliation. |
I50.9 | Heart failure, unspecified | Heart failure medications often require close monitoring and reconciliation after hospitalization. |
Z79.899 | Other long term (current) drug therapy | Indicates chronic medication use and supports the need for medication therapy management. |
Z91.120 | Patient's noncompliance with medication regimen | Identifies adherence issues that are a focus of the medication evaluation. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
99605 | Pharmacist provides a 15–minute, in–person, patient-specific medication evaluation for a new patient | Primary billed service for the initial pharmacist medication therapy evaluation. |
99606 | Pharmacist provides a 15–minute, in–person, patient-specific medication evaluation for an established patient | Used for follow-up visits after the initial 99605 encounter. |
99490 | Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month | May be billed for ongoing medication management when additional monthly care coordination is provided by the care team. |
99483 | Assessment and care planning for cognitive impairment (includes medication review) | Billed when a comprehensive cognitive evaluation with medication review is performed in addition to the medication evaluation. |
90833 | Psychotherapy with evaluation and management when performed with an E/M service (15 minutes) | May be relevant when behavioral health interventions overlap with medication counseling during the visit. |