Can Any Pharmacy Bill for Services Under AB1114?

AB1114 allows pharmacists to get paid for clinical services, but not every pharmacy is ready to take advantage of this. To bill for these services, pharmacies need to follow specific rules, keep proper records, and use the right codes. Here’s what you need to know to get started.
What Do Pharmacies Need to Bill AB1114 Services?

1. Sign Up as a Medi-Cal Provider

To bill Medi-Cal, your pharmacy must be officially enrolled. This means:

Filling out the Medi-Cal Provider Enrollment Application.
Making sure your pharmacists are licensed and meet Medi-Cal’s requirements.
Sending in all required paperwork to prove eligibility.

For more information, check out the Medi-Cal Provider Enrollment Page.

2. Use the Right CPT Codes

To get paid, you need to use specific codes that tell Medi-Cal what services you provided. Here are some common ones:

Medication Therapy Management (MTM):
99605: First 15-minute session for a new patient.
99606: Follow-up sessions for returning patients.
99607: Extra 15-minute blocks of time.
Tobacco Cessation Counseling:
99406: Short session (3-10 minutes).
99407: Longer session (more than 10 minutes).
Immunizations:
90460-90474: Covers vaccines and any counseling provided.
Naloxone Education and Distribution:
G2012: Online or phone check-ins for naloxone education.
Chronic Disease Management:
These services are often billed under MTM or specific disease codes.

3. Keep Good Records

Medi-Cal requires you to:

Clearly document what services you gave.
Track patient outcomes and next steps.
Record how much time you spent on the service.

Good records help you get paid and avoid problems with denied claims.

4. Train Your Team

Your staff needs to:

Understand which services are covered under AB1114.
Use the right workflows for documentation.
Learn how to navigate Medi-Cal billing systems.

Challenges and How to Fix Them

Problem: Confusion About Billing
Solution: Train your team or work with a billing expert to make the process easier.

Problem: Denied Claims
Solution: Double-check codes and documentation before submitting claims. Use Medi-Cal’s resources to ensure accuracy.

Problem: Time Pressures
Solution: Use software to automate things like scheduling, billing, and keeping records.

How to Get Started

Here’s how to begin billing for AB1114 services:

Check Your Pharmacy’s Readiness: Are your staff trained? Do you have the tools you need?
Sign Up with Medi-Cal: Make sure your pharmacy is registered.
Set Up a Billing System: Use software that works with Medi-Cal’s requirements.
Spread the Word: Let your patients know about the new services you offer.

Helpful Links

Final Thoughts

With the right tools and preparation, any pharmacy can benefit from AB1114. By signing up with Medi-Cal, using the correct codes, and keeping good records, your pharmacy can add new revenue while helping your patients.

Need help? RxBB can make Medi-Cal billing simple and stress-free. Contact us today to learn how we can support your pharmacy!