CPT 99606: Pharmacist Medication Evaluation, 15-Minute, Established Patient
CPT code 99606 represents a pharmacist-provided, in-person, 15-minute medication evaluation for an established patient. Nationally, this code captures a growing area of pharmacist-led clinical services intended to improve medication safety, adherence, and care coordination. The code matters as health systems and payers increasingly recognize pharmacists’ roles in chronic disease management and value-based care.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of how the code is defined, typical service settings, and common billing considerations. The publication outlines payer coverage trends and benchmarking where available, summarizes relevant policy updates affecting pharmacist services, and places the service in clinical context — highlighting typical use cases such as chronic disease medication review and polypharmacy management.
This executive summary prepares clinicians, billing staff, and policy stakeholders to understand the purpose of CPT code 99606, what to expect from payer engagement, and where to look for further details on documentation and coding practice. Data not available in the input is noted where specific payer policies, taxonomies, ICD-10 pairings, and related codes would otherwise be described.
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Billing Code Overview
CPT code 99606 describes a 15–minute, in–person, patient–specific medication evaluation provided by a pharmacist for an established patient. The evaluation is based on factors such as the patient’s history and current medication list, with an emphasis on assessing medication use, identifying problems, and recommending adjustments or counseling as appropriate.
Service Type
- Pharmacist medication evaluation (15 minutes), in person
Typical Site of Service
- Outpatient clinic or ambulatory care setting, including pharmacist-run clinics or integrated primary care practices
Clinical & Coding Specifications
Clinical Context
A 68-year-old established patient with multiple chronic conditions (type 2 diabetes mellitus, hypertension, and chronic heart failure) presents to an outpatient clinic pharmacy or ambulatory care clinic for a scheduled medication therapy management visit. The pharmacist performs a focused, face-to-face, 15-minute, patient-specific medication evaluation including review of the patient’s medical history, current medication list (prescription, OTC, and supplements), adherence barriers, recent lab values (e.g., HbA1c, renal function), and assessment for adverse drug events or drug–drug interactions. The visit includes counseling on medication use, identification of therapy optimization opportunities, and documentation of findings and recommendations in the medical record. Typical workflow: referral from primary care or chronic care management team → pre-visit chart review by pharmacist → in-person 15-minute medication evaluation using CPT 99606 → documentation and communication of recommendations to the ordering clinician and care team. Typical site of service: outpatient clinic, ambulatory care pharmacy within a medical practice, or a federally qualified health center where pharmacists provide direct patient care.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Default modifier; no special distiction | Use when no specific modifier applies to the pharmacist-provided service |
22 | Increased procedural services | Use when the pharmacist documents substantially greater complexity or time beyond the typical 15-minute evaluation that justifies additional reimbursement |
25 | Significant, separately identifiable evaluation and management service by the same provider on the same day | Use when a separate E/M service is provided and documented in addition to the medication evaluation |
52 | Reduced services | Use when the service is partially reduced or discontinued at the physician’s or patient’s request |
53 | Discontinued procedure | Use when the medication evaluation was started but terminated due to an unforeseen complication or patient condition |
59 | Distinct procedural service | Use when the pharmacist’s medication evaluation is distinct and separate from another service performed on the same day |
93 | Synchronous telemedicine service rendered via interactive audio and video telecommunications system | Use when the 15-minute evaluation is delivered via real-time audiovisual telehealth (if payer recognizes CPT 99606 via telehealth) |
95 | Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system (CMS-temporary/self-reported) | Use when the service is provided via live video and the payer requires 95 for telehealth |
CG | Service furnished by a resident under the primary care exception (Medicare-specific) | Use when a resident provides the service under allowed supervision rules where CG is required |
GT | Via interactive audio and video telecommunications systems (telehealth) | Use when the evaluation is delivered as live interactive telehealth and payer requires GT |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
3336P0800X | Clinical Pharmacist | Pharmacists providing medication therapy management and in-person medication evaluations |
207Q00000X | Family Medicine | Primary care clinicians who commonly refer patients for pharmacist medication evaluations |
207L00000X | Internal Medicine | Internal medicine clinicians collaborating with pharmacists for chronic disease medication management |
333600000X | Pharmacist | General pharmacist taxonomy for ambulatory care medication services |
362QA2100X | Ambulatory Care Pharmacist | Pharmacist specialized in ambulatory care clinic-based medication management |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
E11.9 | Type 2 diabetes mellitus without complications | Common chronic condition requiring medication review for glycemic control, interactions, and adherence |
I10 | Essential (primary) hypertension | Frequently managed with multiple agents; medication evaluation assesses polypharmacy and adherence |
I50.9 | Heart failure, unspecified | Heart failure medications have narrow therapeutic windows and require reconciliation and monitoring |
E78.5 | Hyperlipidemia, unspecified | Lipid-lowering therapy monitoring and adherence counseling are routine components of MTM |
F17.210 | Nicotine dependence, cigarettes, uncomplicated | Smoking cessation pharmacotherapy and interactions may be reviewed during medication evaluation |
J45.909 | Unspecified asthma, uncomplicated | Asthma controller and rescue medication use, adherence, and inhaler technique can be assessed |
K70.30 | Alcoholic cirrhosis of liver without ascites | Liver disease affects medication selection and dosing; pharmacists assess safety and dosing |
N18.3 | Chronic kidney disease, stage 3 (moderate) | Renal impairment requires dose adjustments and medication safety review |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
99605 | Medication therapy management, initial 15 minutes, face-to-face with a new patient | Used for the initial MTM visit for a new patient; CPT 99606 is for established patients, while 99605 is for new patients |
99607 | Each additional 15 minutes (list separately in addition to codes for primary service) | Used when the medication evaluation requires more than the initial 15 minutes and additional time is billed in 15-minute increments after 99606 |
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 by the practice alongside pharmacist interventions as part of a broader chronic care management program when time thresholds are met |
99487 | Complex chronic care management services, first 60 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month | Relevant when the patient requires more complex medication management integrated into CCM workflows |
99213 | Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes | May be performed by the physician on the same day for a separate, identifiable E/M visit; 25 modifier can be applicable if billed on the same day as 99606 |