Billing Codes

Question 1

Facility Fee (hospital-based clinic)

Answer 1

G0463

Question 2

Diabetes Self-Management Training (DSMT)

Answer 2

Individual - G0108

Group (2-20 people) - G0109

Question 3

Annual Wellness Visit (AWV)

Answer 3

Initial (once in lifetime) - G0438

Subsequent - G0439

Question 4

Transitional Care Management (TCM)
(pharmacists cannot bill)

Answer 4

Medical decision-making of high complexity (seen within 7 days) - 99496

Medical decision-making of moderate complexity (seen within 14 days) - 99495

Question 5

Medication Therapy Management (MTM)

Answer 5

New patient, face-to-face visit, initial 15 min - 99605

Established patient, face-to-face visit, initial 15 min - 99606

Face-to-face visit, for each additional 15 min - 99607

Question 6

Incident-To Level 1
(only one PharmD can bill unless dictated by state)

Answer 6

99211

Question 7

When is an Incident-To Level 2 appropriate?

Answer 7

-Straightforward level of medical decision making
-10-19 min spent

99212

Question 8

When is an Incident-To Level 3 appropriate?

Answer 8

-Low level of medical decision making
-20-29 min spent

99213

Question 9

When is an Incident-To Level 4 appropriate?

Answer 9

-Moderate level of medical decision making
-30-39 min spent

99214

Question 10

When is an Incident-To Level 5 appropriate?

Answer 10

-High level of medical decision making
-40-54 min spent

99215