Summary & Overview
CPT 99607: Pharmacist Medication Evaluation, Additional 15 Minutes
CPT code 99607 represents an additional 15-minute, in-person medication evaluation provided by a pharmacist after an initial 15-minute session. The code captures patient-specific clinical assessment that incorporates the patient’s history and medication list, supporting medication optimization and safety. This service has relevance nationally as pharmacist-led medication management expands across ambulatory care and clinic settings and as payers refine coverage for pharmacist-provided clinical services.
Key payers covered in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the service definition, typical sites of service, and the clinical context for use. The publication also presents payer coverage patterns and benchmarking where available, common billing modifiers and operational considerations for documenting incremental pharmacist time, and implications for coding workflows. Policy updates and payer guidance summaries are included when available to help clinicians and billing teams understand how the code is applied in practice.
The content is designed to help billing managers, pharmacists, and policy analysts quickly understand the purpose of the code, its clinical use case, and the payer landscape affecting reimbursement and operational implementation. Data not available in the input is noted as such in relevant sections.
Billing Code Overview
CPT code 99607 describes an additional in-person, patient-specific medication evaluation provided by a pharmacist after an initial 15 minutes. The service is delivered in 15-minute increments and is based on factors such as the patient’s clinical history and current medication list.
Service Type: Pharmacist-provided, patient-specific medication evaluation (additional 15 minutes)
Typical Site of Service: In-person outpatient or clinic setting where a pharmacist and patient interact directly
Clinical & Coding Specifications
Clinical Context
A 68-year-old patient with multiple chronic conditions (type 2 diabetes mellitus, hypertension, chronic heart failure, and recent hospital discharge for pneumonia) presents to an outpatient clinic for a medication therapy management visit with a clinical pharmacist. The pharmacist conducts an initial in-person, patient-specific medication evaluation that includes review of the comprehensive medication list, past medical history, laboratory results (renal function, electrolytes, HbA1c), adherence assessment, and reconciliation of discharge medications. After the initial 15 minutes of face-to-face review and counseling, the patient requires additional focused assessment and counseling for complex medication changes (titration of heart failure therapy, adjustment of insulin regimen, and clarifying anticoagulation instructions). The pharmacist documents the additional 15 minutes of patient-specific medication evaluation, communicates recommendations to the prescribing clinician, updates the medication list in the electronic health record, and provides patient education materials. Typical site of service is an outpatient clinic or ambulatory pharmacy setting where in-person pharmacist consultations occur, including hospital outpatient departments and community clinic sites.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier required / standard billing | Used when no special billing modifier is applicable and service is billed under usual circumstances. |
22 | Increased procedural services | Use when the additional pharmacist time or complexity significantly exceeds typical expectations and payor allows application for increased work/effort. |
52 | Reduced services | Use when the service provided was partially reduced or truncated but still reported; applicable when the full scope of the additional evaluation was not performed. |
53 | Discontinued procedure | Use when the additional evaluation was started but discontinued due to patient condition or other valid reason. |
59 | Distinct procedural service | Use when the additional 15-minute session is distinct and separate from other services performed on the same day. |
93 | Synchronous telemedicine audio-only | Use only if allowed and the additional 15-minute evaluation is provided via audio-only telecommunication and payor accepts this modifier for pharmacist services. |
95 | Synchronous telemedicine service rendered via real-time interactive audio and video telecommunications system | Use if the additional 15-minute evaluation is delivered via live audio-video telehealth and the payor recognizes telehealth for pharmacist-provided services. |
CG | California-specific modifier (pharmacist services) | Use when state or payor-specific billing rules require this modifier for pharmacist clinical services in applicable programs. |
GT | Via interactive audio and video telecommunications system | Use for telehealth delivery of the additional 15-minute evaluation when payor requires GT for telemedicine claims. |
PO | Purchased or provided other party | Use per payer guidance when services are provided by a contracted entity or third-party and payor requires this indicator. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 174400000X | Pharmacy | Clinical pharmacists providing medication therapy management and patient-specific medication evaluations. |
| 207RH0000X | Internal Medicine | Primary care physicians collaborating with pharmacists and referencing pharmacist recommendations. |
| 207RN0400X | Cardiology | Cardiologists who commonly involve pharmacists for heart failure, anticoagulation, and complex cardiac medication management. |
| 207Q00000X | Family Medicine | Family physicians in ambulatory settings coordinating care and accepting pharmacist medication review recommendations. |
| 363L00000X | Clinical Nurse Specialist | Advanced practice clinicians who may collaborate with pharmacists for medication adjustments and patient education. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
E11.9 | Type 2 diabetes mellitus without complications | Diabetes commonly requires medication adjustments and adherence counseling during pharmacist medication evaluations. |
I50.9 | Heart failure, unspecified | Heart failure patients often need complex medication titration and monitoring handled in extended pharmacist visits. |
I10 | Essential (primary) hypertension | Hypertension management frequently involves medication reconciliation and dose optimization during pharmacist encounters. |
J18.9 | Pneumonia, unspecified organism | Recent hospitalization for pneumonia may trigger post-discharge medication reconciliation and additional pharmacist counseling. |
Z79.01 | Long term (current) use of anticoagulants | Anticoagulation management requires detailed counseling, monitoring, and medication reconciliation often addressed in extended visits. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
99606 | Medication therapy management service(s) provided by a pharmacist, face-to-face with patient, initial 15 minutes, face-to-face | Represents the initial 15-minute pharmacist medication evaluation; 99607 is used for each additional 15-minute increment after 99606. |
99605 | Medication therapy management service(s) provided by a pharmacist, in a telehealth or non–face-to-face setting, initial 15 minutes | Used when the initial medication therapy management is performed remotely; billing context differs from in-person codes 99606/99607. |
99495 | Transitional care management services with moderate medical decision complexity, communication with patient/caregiver within 2 business days | Often part of post-discharge workflows where pharmacist medication evaluation (99607) supplements transitional care and supports medication reconciliation. |
99406 | Smoking and tobacco use cessation counseling visit, intermediate, greater than 3 minutes up to 10 minutes | Example of a brief counseling service that may be provided in the same visit but billed separately per payer rules if distinct and separately identifiable. |
99078 | Physician/nurse practitioner/other qualified health care professional educational supplies, nonphysician provider, group setting | May be used for structured patient education sessions related to medication therapy when billing rules permit and when education is a separate billable service. |