Reimbursement Rates for Pharmacist Services Under AB1114

AB1114 ensures that pharmacists receive fair compensation for providing clinical services. Understanding reimbursement rates and billing codes is crucial for maximizing revenue. Here’s a detailed breakdown for reimbursement Rates for Common Services

1. Medication Therapy Management (MTM):

• CPT Codes: 99605 (initial session), 99606 (follow-up session), 99607 (additional increments)
• Reimbursement Example: Around $52 for a 15-minute initial session (actual rates may vary based on Medi-Cal updates).

2. Tobacco Cessation Counseling:

• CPT Codes: 99406 (intermediate session), 99407 (intensive session)
• Reimbursement Example: $27 for a 10-minute session and $45 for longer sessions.

3. Immunizations:

• CPT Codes: 90460-90474
• Reimbursement Example: Around $25 per vaccine administration, excluding the cost of the vaccine itself.

4. Chronic Disease Management:

• Billing Details: Services often fall under MTM codes; reimbursement varies based on time and complexity.

5. Naloxone Education and Distribution:

• CPT Codes: G2012 or pharmacist-specific billing codes.
• Reimbursement Example: Varies by educational session and naloxone cost.

Maximizing Reimbursements

To ensure you capture the full value of these services:

• Train Staff: Educate your team on proper documentation and billing practices.
• Use Technology: Leverage pharmacy management software to streamline billing and stay compliant with Medi-Cal guidelines.
• Monitor Updates: Regularly review changes to Medi-Cal reimbursement policies to stay ahead.

Source Links

• California Department of Health Care Services – Medi-Cal Billing Guidelines
• Centers for Medicare & Medicaid Services (CMS) – CPT Codes

Conclusion

Understanding and applying the correct reimbursement rates and codes for AB1114 services is vital for independent pharmacies to thrive.

Need assistance with billing and compliance? Contact RxBB for solutions tailored to your pharmacy’s success!